Elsevier

Bone

Volume 32, Issue 5, May 2003, Pages 468-473
Bone

Regular article
The components of excess mortality after hip fracture

https://doi.org/10.1016/S8756-3282(03)00061-9Get rights and content

Abstract

A high excess mortality is well described after hip fracture. Deaths are in part related to comorbidity and in part due directly or indirectly to the hip fracture event itself (causally related deaths). The aim of this study was to examine the quantum and pattern of mortality following hip fracture. We studied 160,000 hip fractures in men and women aged 50 years or more, in 28.8 million person-years from the patient register of Sweden, using Poisson models applied to hip fracture patients and the general population. At all ages the risk of death was markedly increased compared with population values immediately after the event. Mortality subsequently decreased over a period of 6 months, but thereafter remained higher than that of the general population. The latter function was assumed to account for deaths related to comorbidity and the residuum assumed to be due to the hip fracture. Causally related deaths comprised 17–32% of all deaths associated with hip fracture (depending on age) and accounted for more than 1.5% of all deaths in the population aged 50 years or more. Hip fracture was a more common cause for mortality than pancreatic or stomach cancer. Thus, interventions that decreased hip fracture rate by, say, 50% would avoid 0.75% or more of all deaths.

Introduction

It is widely recognized that osteoporosis is associated with increased mortality [1], [2], [3]. For each standard deviation decrease in bone mineral density, the mortality risk is increased 1.5-fold. Excess mortality is also well described in patients who develop osteoporotic fractures at sites characteristic for osteoporosis including the spine (radiographic and clinical fractures) and hip [4], [5], [6], [7], [8], [9], [10], [11], [12], [13]. In contrast no excess mortality has been shown following fractures of the distal forearm [6], [7]. In the case of hip fracture, most deaths occur in the first 3 to 6 months following the event [8], [12], [14], [15], and excess mortality decreases thereafter, though not to that of the general population. This complex pattern of mortality could be explained on the basis of deaths directly or indirectly attributable to the hip fracture event, and those that are due to comorbidity.

The present study examines the pattern of mortality following hip fracture in a large population, to estimate the proportion of deaths due to fracture. The aim was to quantify the significance of fracture-related mortality and its impact on burden of disease, trial design of treatments, and health economic evaluation.

Section snippets

Patients and methods

We studied 158,589 admissions to Swedish hospitals for hip fracture in men and women aged 50 years or more, between the years of 1987 and 1996, drawn from a population of 28.8 million person-years. The source used was the National Swedish Register (the patient register of the National Board of Health and Welfare) that documents each hospital admission. A unique personal identifier permitted the tracking of individuals for multiple admissions. All patient records were examined to identify

Results

We identified 158,589 patients hospitalized for hip fracture in a follow up of 452.4 thousand person-years. Age- and sex-specific hip fracture rates are shown in Table 1. Within the period 1987–1996 there were 25,540 deaths among men and 58,591 deaths in women with hip fracture.

Using the Poisson model, the mortality at 6 months and at 5 years after hip fracture was compared with that of the general population (Table 2). Comparisons of mortality hazard at 6 months and 5 years indicate a much

Discussion

There have been many previous studies that have documented an increase in mortality risk following hip fracture in both men and women [4], [6], [8], [12], [13], [18], [19], [20]. The mortality risk appears to be substantially higher in men than in women, as found in the present study, even accounting for the higher mortality rates for men in the general population.

There have been few attempts to quantify the components of mortality [17], [21]. Patients with hip fracture have significant

Acknowledgements

We are grateful to the National Board of Health and Social Welfare, EPC, Sweden, for access to the patient records of Sweden. We acknowledge the unrestricted support of The International Osteoporosis Foundation, Lilly, Hologic, Roche, Novartis, and IGEA.

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