Compound risk of high mortality following osteoporotic fracture and refracture in elderly women and men

Abstract

After fracture there is increased risk of refracture and premature mortality. These outcomes, particularly premature mortality following refracture, have not previously been studied together to understand overall mortality risk. This study examined the long-term cumulative incidence of subsequent fracture and total mortality with mortality calculated as a compound risk and separated according to initial and refracture. Community-dwelling participants aged 60þ years from Dubbo Osteoporosis Epidemiology Study with incident fractures, followed prospectively for further fractures and deaths from 1989 to 2010. Subsequent fracture and mortality ascertained using cumulative incidence competing risk models allowing four possible outcomes: death without refracture; death following refracture; refracture but alive, and event-free. There were 952 women and 343 men with incident fracture. Within 5 years following initial fracture, 24% women and 20% men refractured; and 26% women and 37% men died without refracture. Of those who refractured, a further 50% of women and 75% of men died, so that total 5-year mortality was 39% in women and 51% in men. Excess mortality was 24% in women and 27% in men. Although mortality following refracture occurred predominantly in the first 5 years post-initial fracture, total mortality (post-initial and refracture) was elevated for 10 years. Most of the 5-year to 10-year excess mortality was associated with refracture. The long-term (>10 years) refracture rate was reduced, particularly in the elderly as a result of their high mortality rate. The 30% alive beyond 10 years postfracture were at low risk of further adverse outcomes. Refractures contribute substantially to overall mortality associated with fracture. The majority of the mortality and refractures occurred in the first 5 years following the initial fracture. However, excess mortality was observed for up to 10 years postfracture, predominantly related to that after refracture.

A Retrospective Longitudinal Database Study of Persistence and Compliance with Treatment of Osteoporosis in Hungary

“…The occurrence of any new fracture and older age (C70 years) were associated with significant increases in the risks of fracture, fracture-related hospitalization and death (any new fracture: 273, 691 and 99 %, respectively; age C70 years: 37, 109 and 287 %, respectively), providing further evidence that previous fracture and age are both significant risk factors for future fracture(s). Our data are also supported by the Australian Dubbo Osteoporosis Epidemiology Study, in which fracture was associated with increased mortality for up to 10 years following an initial fracture, particularly in those who had a second fracture within 5 years of their initial fracture [40]. In addition to good compliance, good persistence may also reduce the risk of mortality in patients with osteoporosis.…”

Meeting international standards of secondary fracture prevention: a survey on Fracture Liaison Services in the Netherlands

“…Of all low-trauma fractures in patients over 50 years of age, subsequent fractures accounted for 40 % of fractures in women and 24 % in men [12]. After any osteoporotic fracture in patients over 60 years of age, 24 % of women (31 % of survivors) and 20 % of men (32 % of survivors) had a subsequent fracture within 5 years [13]. Using composite risk analysis that takes into account subsequent fracture risk and mortality, the risk of subsequent fractures reached 40 % in survivors of hip fracture during a 5-year follow-up [14], 80 % of survivors of a hip fracture during a 20-year follow-up [15] and 20 % of survivors of a hand or foot fracture during a 5-year follow-up [16].…”

Comparative trends in incident fracture rates for all long-term care and community-dwelling seniors in Ontario, Canada, 2002–2012

“…The risk of a first [3] and subsequent [4][5][6] osteoporotic fracture increases with age. Among those aged 80 years and older, the 5-year risk of fracture has been estimated as 17 % in women and 11 % in men [3].…”