Cause-specific excess mortality after hip fracture: the Norwegian Epidemiologic Osteoporosis Studies (NOREPOS)

Abstract

Background Information on cause of death may help appraise the degree to which the high excess mortality after hip fracture reflects pre-existing comorbidities or the injury itself. We aimed to describe causes of death and cause-specific excess mortality through the first year after hip fracture. Methods For studying the distribution of causes of death by time after hip fracture, we calculated age-adjusted cause-specific mortality at 1, 3, 6 and 12 months in patients hospitalized with hip fracture in Norway 1999–2016. Underlying causes of death were obtained from the Norwegian Cause of Death Registry and grouped by the European Shortlist for Causes of Death. For estimating excess mortality, we performed flexible parametric survival analyses comparing mortality hazard in patients with hip fracture (2002–2017) with that of age- and sex matched controls drawn from the Population and Housing Census 2001. Results Of 146,132 Norwegians with a first hip fracture, a total of 35,498 (24.3%) died within one year. By 30 days post-fracture, external causes (mainly the fall causing the fracture) were the underlying cause for 53.8% of deaths, followed by circulatory diseases (19.8%), neoplasms (9.4%), respiratory diseases (5.7%), mental and behavioural disorders (2.0%) and diseases of the nervous system (1.3%). By one-year post-fracture, external causes and circulatory diseases together accounted for approximately half of deaths (26.1% and 27.0%, respectively). In the period 2002–2017, cause-specific one-year relative mortality hazard in hip fracture patients vs. population controls ranged from 1.5 for circulatory diseases to 2.5 for diseases of the nervous system in women, and correspondingly, from 2.4 to 5.3 in men. Conclusions Hip fractures entail high excess mortality from all major causes of death. However, the traumatic injury of a hip fracture is the most frequently reported underlying cause of death among older patients who survive less than one year after their fracture.

Postfracture survival in a population-based study of adults aged ≥66 yr: a call to action at hospital discharge

“…The greatest reduction in survival was found to occur within the first month after hip, vertebral, and pNHNV fractures for both males and females, which is in line with recent research 15 , 28 and suggests a high relative impact of short-term factors on survival, with the effects persisting over time. 29 Therefore, the most critical period for implementing clinical interventions aimed at improving post-fracture prognosis appears to be immediately after a fracture occurs, ideally before patients are discharged from fracture care. However, considering the immediate need for introducing secondary prevention strategies, primary fracture prevention is also crucial to prevent a fracture from occurring in the first place.…”

Investigation of the predictive value of systemic immune inflammation index (SII) and prognostic nutritional index (PNI) on mortality in patients with endoprosthesis after hip fracture

“…However, as in all treatment methods, the mortality rates are high when using the endoprosthesis method. [ 18 – 20 ] On the other hand, there have not been sufficient studies on the reasons for this mortality.…”

Home Meal Replacement Fortified with Eggshell Powder and Vitamin D Prevents Bone Loss in Postmenopausal Women: A Randomized, Double-Blind, Controlled Study

“…Osteoporosis, one of the major health problems of postmenopausal women, increases fracture-related mortality [ 1 ]. Considering that the estrogen level drops during the menopausal transition period result in more bone resorption than formation, proactive measures are needed for postmenopausal women.…”