Hip Fracture and Increased Short-term but Not Long-term Mortality in Healthy Older Women

Abstract

Background Fractures have been associated with subsequent increases in mortality, but it is unknown how long that increase persists. Methods 5580 women from a large community-based multicenter US prospective cohort of 9704 (Study of Osteoporotic Fractures) were followed prospectively for almost 20 years. We age-matched 1116 hip fracture cases with four controls (n=4464). To examine the effect of health status, we examined a healthy older subset (n=960) aged 80+ who attended the 10-year follow-up examination, and reported good/excellent health. Incident hip fractures were adjudicated from radiology reports by study physicians. Death was confirmed by death certificates. Results Hip fracture cases had two-fold increased mortality in the year after fracture compared to controls [16.9% vs. 8.4%; Odds Ratio (OR)=2.4; 95% Confidence Interval (CI) 1.9, 3.1]. When examined by age and health status, short-term mortality was increased in those aged 65 to 70 (16.3% vs 3.7%; OR=5.0; 2.6, 9.5), aged 70 to 79 (16.5% vs 8.9%; OR=2.4; 1.8, 3.3), and only in aged 80+ with good/excellent health (15.1% vs. 7.2%; OR=2.8; 1.5, 5.2). After the first year, survival of hip fracture cases and controls was similar except in those aged 65 to 70 who continued to have increased mortality. Conclusions Short-term mortality is increased after hip fracture in women aged 65 to 79 and in exceptionally healthy women 80 or older. Women 70 and older return to previous risk levels after a year. Interventions are needed to decrease mortality in the year after hip fracture, when mortality risk is highest.

Comprehensive geriatric care for patients with hip fractures: a prospective, randomised, controlled trial

“…(64) Although mortality risk is lower among those below 70 years, the relative risk of dying is increased as compared to people of the same age without fracture. (69,70) The risk of dying is largest during the first 3 months after the fracture, but is still increased decades later. (71) In a material from Southern-Norway , overall mortality was 21% after one year and 59% after five years.…”

“…(72) Cardiac infarction, stroke and cancer are the most important causes of death, but pneumonia and urinary tract infections are common complications and reasons for in-hospital mortality. (70) In-hospital mortality varies between different studies, from 1.5% to almost 5%. (73,74) Differences in LOS and discharge practices may explain some of these differences, while differences in treatment strategies also may cause different mortality.…”

Total Hip Arthroplasty for Hip Fractures

“…The 2 intraoperative fractures (2.2% compared to reported rates of 5.6% 22 ) were stable, localized on the greater trochanter, and treated with cerclage so did not require any modification of postoperative weight bearing. Transfusion was needed in 37 (39.7%) patients, with these patients receiving an average of 2 units (1)(2)(3)(4)(5). No patient died during surgery.…”

“…1,2 Threequarters of all hip fractures occur in women, with a lifetime risk of having any osteoporotic fracture ranging between 40% and 50%, as opposed to only a 13% to 22% risk in men. 2,3 As people age, the incidence of hip fractures increases, with individuals aged 85 years 10 times as likely to have hip fractures as those aged 65 to 69 years. 4 With standard posthip fracture interventions, 13.5% of older adults die within 6 months after injury and 24% within 1 year.…”

Mortality and Revision Surgery Are Increased in Patients With Parkinson’s Disease and Fractures of the Femoral Neck

“…Mortality after hip fractures has been well documented with 1-year mortality rates varying between 12% and 37% [13,19,23,37]. Predictors of mortality after hip fracture include male sex, advanced age, high ASA classification, postoperative complications, and major medical comorbidities including cancer, chronic obstructive pulmonary disorder, and congestive heart failure [1,18].…”