Regular articleThe components of excess mortality after hip fracture
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.
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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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