Fracture mortality: associations with epidemiology and osteoporosis treatment

Abstract

The rates of incident osteoporotic fractures seem to be stabilizing; however, fragility fractures are still associated with considerable disability, costs and an increased risk of mortality, which is particularly the case for fractures of the hip and vertebra. Mortality is usually highest during the first year after fracture; however, a notably increased mortality risk might persist for several years after the event. In addition to its efficacy in the prevention of new and recurrent osteoporotic fractures, medical treatment has been associated with improved survival after osteoporotic fractures. Observational studies and randomized controlled clinical trials have reported increased survival in patients with a fracture who are treated with bisphosphonates. Rates of medical treatment in patients with osteoporosis remain low, and although the rationale for the putative increase in survival is unclear, this emerging evidence might help further justify the use of medical treatment after fracture. However, further work is needed before medical therapy for mortality prevention in patients with osteoporotic fractures is accepted.

The epidemiology of mortality after fracture in England: variation by age, sex, time, geographic location, and ethnicity

“…The reasons for the sex-difference in post-fracture mortality are not completely understood, and have been most comprehensively evaluated after hip fracture. Male hip fracture patients are on average 4 years younger, but sicker than their female counterparts [6,16]. However, even after adjustment for age, drug use, and comorbidities, the sex-difference remained in several studies among hip fracture patients but also relative to the general population, which is in line with our results for the composite outcome of fracture.…”

“…The unchanged mortality outcome relative to the general population implies that the fracture-related mortality has not declined. Future investigations should focus on the cost benefit of targeted interventions including the role of multidisciplinary care, comorbidity management, nutrition, and pharmacological treatment where there is limited but conflicting evidence for reduced mortality with use of bisphosphonates (zoledronic acid) following hip fracture [16]. These interventions may be implemented through a Fracture Liaison Service [30], but it has been shown that there is great heterogeneity in quality of FLS services, which needs to be improved [31].…”

Vertebroplasty and Kyphoplasty for Osteoporotic Vertebral Fractures: What Are the Latest Data?

“…61 In an analysis of the Medicare population in the United States (97,142 patients with VCF, 428,956 controls), the mortality rate for patients with VCF was twice that of matched controls. The 3-and 5-year mortality rates for patients with VCF were 46% and 69%, respectively, compared with 22% and 36% for matched controls.…”

Correlation between bone mineral density, isokinetic peak torque and postural balance in postmenopausal women

“…These variables, when altered, decrease the functional status and constitute a significant risk factor for an increase in the incidence of falls and a consequent risk of fractures (4) , which leads in some cases to morbidity or even mortality (5,6) . However, the literature is inconsistent and inconclusive as to the relation between these variables in postmenopausal women.…”