Bone health

How long does increased mortality risk persist after fracture?

Excess mortality for all proximal and low leg fractures persist over 5 years post fracture but is most pronounced in the first year, a study from the Garvan Institute shows.

Lead researcher Dr Thach Tran who presented the results of the nationwide register based follow up study to the conference said the findings highlighted the need for early intervention in this patient population.

The study involved all Danish individuals aged over 50 who had a fragility fracture in 2001. The researchers used relative survival ratio (RSR) to examine excess deaths attributable to individual types of fracture, taking into account time-related mortality changes in the background population.

Overall 9,500 men and 21,000 women had a first fragility fracture in the year of the study and 3,198 and 6,589 deaths occurred respectively.

The research team saw a significant excess mortality following all proximal and lower leg fractures, with the majority occurring within the first year post-fracture before gradually declining.

Hip fractures were associated with the highest excess mortality (1-year RSR of 0.67 and 0.80, ~ excess mortality of 33% and 20% in men and women, respectively).

Excess mortality at one year after other femur or pelvic fracture was 20-25%, compared with 10% following vertebral, 5-10% following humerus, rib and clavicle, and 3% following lower leg fractures.

A significant, although smaller excess mortality was still observed until approximately 10, 7 and 5 years after hip, femur and other proximal fractures.

For every 3 men and 5 women with a hip or femur fracture one extra death occurred above expected in the first year post-fracture, compared with one extra death for 48 men and 33 women with lower leg fracture.

Dr Tran told delegates it was unclear what the mechanism was behind fracture and an increased risk of mortality.

A  possible explanation could be that hip fracture, for example, is associated with major post operative complications such as infection, deep vein thrombosis and pulmonary embolism.

“Some studies have also found hip fracture to be associated with acute MI which is a leading cause of mortality,” he said.

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