Risk of Mortality Following Clinical Fractures

Cauley, Jane A.; Thompson, Desmond; Ensrud, Kristine E.; Scott, Jean C.; Black, Dennis M.

doi:10.1007/s001980070075

Cited by 824 publications

(475 citation statements)

References 15 publications

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“…Other studies reported that increased mortality after hip and vertebral fractures was consistent over the initial five-year period. (4,6,8,11) In the present study, prevalent morphometric vertebral deformity and prevalence of hip fracture were not associated with increased mortality. Inconsistency between our report and many previous studies can be explained by differences between incidence and prevalence of fracture, because prevalent vertebral deformity and hip fracture in our study included those cases that had developed many years in the past.…”

Section: Journal Of Bone and Mineral Researchsupporting

confidence: 38%

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Height loss starting in middle age predicts increased mortality in the elderly

Masunari

Fujiwara

Kasagi

et al. 2011

Journal of Bone and Mineral Research

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The purpose of this study was to determine the mortality risk among Japanese men and women with height loss starting in middle age, taking into account lifestyle and physical factors. A total of 2498 subjects (755 men and 1743 women) aged 47 to 91 years old underwent physical examinations during the period 1994 to 1995. Those individuals were followed for mortality status through 2003. Mortality risk was estimated using an age-stratified Cox proportional hazards model. In addition to sex, adjustment factors such as radiation dose, lifestyle, and physical factors measured at the baseline-including smoking status, alcohol intake, total cholesterol, blood pressure, and diagnosed diseases-were used for analysis of total mortality and mortality from each cause of death. There were a total of 302 all-cause deaths, 46 coronary heart disease and stroke deaths, 58 respiratory deaths including 45 pneumonia deaths, and 132 cancer deaths during the follow-up period. Participants were followed for 20,787 person-years after baseline. Prior history of vertebral deformity and hip fracture were not associated with mortality risk. However, more than 2 cm of height loss starting in middle age showed a significant association with all-cause mortality among the study participants (HR ¼ 1.76, 95% CI 1.31 to 2.38, p ¼ 0.0002), after adjustment was made for sex, attained age, atomic-bomb radiation exposure, and lifestyle and physical factors. Such height loss also was significantly associated with death due to coronary heart disease or stroke (HR ¼ 3.35, 95% CI 1.63 to 6.86, p ¼ 0.0010), as well as respiratory-disease death (HR ¼ 2.52, 95% CI 1.25 to 5.22, p ¼ 0.0130), but not cancer death. Continuous HL also was associated with all-cause mortality and CHD-or stroke-caused mortality. Association between height loss and mortality was still significant, even after excluding persons with vertebral deformity. Height loss of more than 2 cm starting in middle age was an independent risk factor for cardiovascular and respiratory-disease mortality among the elderly, even after adjusting for potential risk factors. ß

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Section: Journal Of Bone and Mineral Researchsupporting

confidence: 38%

“…M any studies have shown increased fracture risk (1)(2)(3) and mortality (4)(5)(6)(7)(8) after clinical vertebral fracture. Even subjects with no clinical fracture and little pain but with vertebral deformity detected by X-ray showed slightly increased mortality.…”

Section: Introductionmentioning

confidence: 99%

Height loss starting in middle age predicts increased mortality in the elderly

Masunari

Fujiwara

Kasagi

et al. 2011

Journal of Bone and Mineral Research

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“…Several other studies have shown that in postmenopausal women the consequences of vertebral fractures are markedly influenced by the number and severity of prior vertebral fractures [7,27]. It has been reported that patients with multiple fractures are at increased risk of morbidity and mortality [2,14]. Therefore, the recognition of vertebral fractures is critical for the prediction of possible future fractures.…”

Section: Introductionmentioning

confidence: 99%

Undiagnosed Vertebral Fractures Influence Quality of Life in Postmenopausal Women With Reduced Ultrasound Parameters

Nuti

Caffarelli

Guglielmi

et al. 2014

Clinical Orthopaedics &Amp; Related Research

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Background Osteoporosis, a multifactorial systemic skeletal disease characterized by low bone mass and microarchitectural deterioration of bone tissue leading to increased bone fragility, is a worldwide public health problem. Vertebral fractures affect approximately 20% of postmenopausal women and are a hallmark of osteoporosis, but they may pass unnoticed, although they may lead to long-term immobility and disability. Questions/purposes The aims of the present study were (1) to determine the prevalence and the severity of vertebral fractures in a large cohort of Italian women aged 60 years or older with reduced values of quantitative ultrasound parameters; and (2) to assess whether vertebral fractures and other variables may be associated with health-related quality of life. Methods A total of 2450 women without back pain aged 60 years or older, after the completion of the Quality of Life Questionnaire of the European Foundation for Osteoporosis QUALEFFO, underwent quantitative ultrasound evaluation of the calcaneus; in those with a stiffness t-score of B À2 (n = 1194), radiographic evaluation of the thoracic and lumbar spine was carried out and then quantitative morphometry was performed by dedicated software (MorphoXpress). The radiographic analysis was carried out on 885 women who presented films of adequate quality. Multivariate regression was used to adjust for confounding variables. Results Of those who underwent radiographic analysis, 681 had no vertebral fractures, and 204 women (23.1%) had one or more previously undiagnosed vertebral fractures. The prevalence of previously undiagnosed vertebral fractures increased with advancing age with more than 30% of women older than 75 years having at least one fracture. Older age, body mass index, and severe vertebral fractures were independently associated with a worse total QUALEFFO score. Conclusions We found that approximately one in four women showed evidence of undiagnosed vertebral fractures, and there was a strong age effect trend. Moreover, the severity grade of vertebral fractures, more than the number of fractures, was associated with a worsening of healthrelated quality of life as assessed by QUALEFFO. These findings confirm the clinical relevance of an early diagnosis of vertebral fractures and seem to support the usefulness of quantitative ultrasound measurements in the stratification of postmenopausal women at increased fracture risk.

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“…Skeletal injuries are common in the elderly, and fractures are associated with a high rate of morbidity and mortality [5,24]. In most healthy adults immobility associated with fracture healing does not significantly impact quality of life of the patient, but in elderly patients the period of convalescence required for fracture repair is a significant cause of post-trauma morbidity and mortality [12,20].…”

Section: Introductionmentioning

confidence: 99%

Cellular basis for age-related changes in fracture repair

Miclau

et al. 2005

J. Orthop. Res.

194

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The goal of this work was to define cellular and molecular changes that occur during fracture healing as animals age. We compared the molecular, cellular, and histological progression of skeletal repair in juvenile (4 weeks old), middle-aged (6 months old), and elderly (18 months old) mice at 3, 5, 7, 10, 14,21,28, and 35 days post-fracture, using a non-stabilized tibia fracturqmodel. Our histological and molecular analyses demonstrated that there was a sharp decline in fracture healing potential between juvenile and middle-aged animals, while a more subtle decrease in healing potential was apparent between middle-aged and elderly mice. By three days after fracture, chondrocytes expressing Collagen type ZZ, and osteoblasts expressing osteocalcin, were present in calluses of juvenile, but not middle-aged or elderly, mice. At day 5 immature chondrocytes and osteoblasts were observed in calluses of middle-aged and elderly mice. While at this time, chondrocytes in juvenile mice were expressing Collagen type X (ColX) indicating that chondrocyte maturation was already underway. At day 7, chondrocytes expressing ColX were abundant in middle-aged mice while a small domain of ColX-positive chondrocytes were observed in elderly mice. Further, in juvenile and middle-aged mice, but not elderly mice, vascular invasion of the cartilage was underway by day 7. Juvenile mice had replaced nearly all of the cartilage by day 14, while cartilage was still present in the callus of middle-aged mice at day 21 and in elderly mice at day 28. In addition to these delays, histomorphometry revealed that elderly and middle-aged mice formed less bone than juveniles (p < 0.001), while cartilage production was unaffected (p > 0.22). Collectively, these data suggest that enhancing cell differentiation, improving osteoblast function, and accelerating endochondral ossification may significantly benefit the elderly.

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Risk of Mortality Following Clinical Fractures

Cited by 824 publications

References 15 publications

Height loss starting in middle age predicts increased mortality in the elderly

Height loss starting in middle age predicts increased mortality in the elderly

Undiagnosed Vertebral Fractures Influence Quality of Life in Postmenopausal Women With Reduced Ultrasound Parameters

Cellular basis for age-related changes in fracture repair

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