Population-Wide Impact of Non-Hip Non-Vertebral Fractures on Mortality

Abstract

Data on long-term consequences of non-hip non-vertebral (NHNV) fractures, accounting for approximately two-thirds of all fragility fractures, are scanty. Our study aimed to quantify the population-wide impact of NHNV fractures on mortality. The national populationbased prospective cohort study (Canadian Multicentre Osteoporosis Study) included 5526 community dwelling women and 2163 men aged 50 years or older followed from July 1995 to September 2013. Population impact number was used to quantify the average number of people for whom one death would be attributable to fracture and case impact number to quantify the number of deaths out of which one would be attributable to a fracture. There were 1370 fragility fractures followed by 296 deaths in women (mortality rate: 3.49; 95% CI, 3.11 to 3.91), and 302 fractures with 92 deaths in men (5.05; 95% CI, 4.12 to 6.20). NHNV fractures accounted for threequarters of fractures. In women, the population-wide impact of NHNV fractures on mortality was greater than that of hip and vertebral fractures because of the greater number of NHNV fractures. Out of 800 women, one death was estimated to be attributable to a NHNV fracture, compared with one death in 2000 women attributable to hip or vertebral fracture. Similarly, out of 15 deaths in women, one was estimated to be attributable to a NHNV fracture, compared with one in over 40 deaths for hip or vertebral fracture. The impact of forearm fractures (ie, one death in 2400 women and one out of 42 deaths in women attributable to forearm fracture) was similar to that of hip, vertebral, or rib fractures. Similar, albeit not significant, results were noted for men. The study highlights the important contribution of NHNV fractures on mortality because many NHNV fracture types, except for the most distal fractures, have serious adverse consequences that affect a significant proportion of the population.

Mortality After Osteoporotic Fractures: What Proportion Is Caused by Fracture and Is Preventable?

“…The study of Tran and colleagues using data from the Canadian Multicentre Osteoporosis Study (CaMos) examined the association of mortality with low-trauma fractures at all skeletal sites in order to estimate not only the relative risk of long-term mortality (over a median follow-up time of 14 years) attributable to lowtrauma fractures but also the impact of fractures on mortality at the population level. (40) The authors hypothesized that although the relative risk of mortality associated with non-hip nonvertebral (NHNV) fractures (as an aggregate group) was likely to be lower compared to hip and clinical vertebral fractures, the mortality impact at the population level of NHNV may be as high as for hip and clinical vertebral fractures. This hypothesis was confirmed; three-quarters of all fractures occurred at NHNV skeletal sites, and the number of deaths in the entire population associated with NHNV fractures was higher than for hip or clinical vertebral fractures.…”

Recommendations for the conduct of economic evaluations in osteoporosis: outcomes of an experts’ consensus meeting organized by the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO) and the US branch of the International Osteoporosis Foundation

“…More studies on the duration of the excess mortality attributable to the fracture event would also be needed. Recently, a study also suggested a mortality effect after non-hip non-vertebral fractures [66] and more studies would be interesting to confirm this. Further work would also be needed to address the excess mortality after a fracture that can be directly attributable to the fracture event.…”

Reduced Bone Loss Is Associated With Reduced Mortality Risk in Subjects Exposed to Nitrogen Bisphosphonates: A Mediation Analysis

“…Furthermore, their prevalence is expected to rise as a consequence of increasing life expectancy and thus the number of individuals at risk . The burden of osteoporotic fracture resides not only in their increased risk of subsequent fracture but also in increased mortality risk …”

“…(2) The burden of osteoporotic fracture resides not only in their increased risk of subsequent fracture (3)(4)(5) but also in increased mortality risk. (6)(7)(8)(9) Bisphosphonates are currently considered first-line treatment for osteoporosis worldwide (10,11) with abundant evidence of their ability to reduce both vertebral and nonvertebral fracture risk. (12)(13)(14) More recently, bisphosphonates have been also linked to improved survival.…”