Osteoporosis International

, Volume 20, Issue 10, pp 1633–1650 | Cite as

Excess mortality following hip fracture: a systematic epidemiological review

  • B. AbrahamsenEmail author
  • T. van Staa
  • R. Ariely
  • M. Olson
  • C. Cooper


Summary This systematic literature review has shown that patients experiencing hip fracture after low-impact trauma are at considerable excess risk for death compared with nonhip fracture/community control populations. The increased mortality risk may persist for several years thereafter, highlighting the need for interventions to reduce this risk.

Patients experiencing hip fracture after low-impact trauma are at considerable risk for subsequent osteoporotic fractures and premature death. We conducted a systematic review of the literature to identify all studies that reported unadjusted and excess mortality rates for hip fracture. Although a lack of consistent study design precluded any formal meta-analysis or pooled analysis of the data, we have shown that hip fracture is associated with excess mortality (over and above mortality rates in nonhip fracture/community control populations) during the first year after fracture ranging from 8.4% to 36%. In the identified studies, individuals experienced an increased relative risk for mortality following hip fracture that was at least double that for the age-matched control population, became less pronounced with advancing age, was higher among men than women regardless of age, was highest in the days and weeks following the index fracture, and remained elevated for months and perhaps even years following the index fracture. These observations show that patients are at increased risk for premature death for many years after a fragility-related hip fracture and highlight the need to identify those patients who are candidates for interventions to reduce their risk.


Excess mortality Femoral neck fracture Fragility-related fracture Hip fracture Osteoporotic hip fracture Systematic review 



Editorial support was provided by Tracey Lonergan (Anthemis Consulting Ltd).

Funding sources

This work was supported by an unrestricted educational grant from Novartis Pharmaceutical Corporation.

Conflicts of interest

B. Abrahamsen receives consultancy fees from Nycomed and Novartis and research grants from Roche; T.P. van Staa works for the General Practice Research Database (GPRD), which is owned by the UK Department of Health and operates within the Medicines and Healthcare products Regulatory Agency (MHRA). GPRD is funded by the MHRA, Medical Research Council, various universities, contract research organizations, and pharmaceutical companies; C. Cooper has no conflict of interest to declare; R. Ariely is an employee of Novartis Pharmaceutical Corporation; M. Olson is an employee of Novartis Pharma AG.


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Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2009

Authors and Affiliations

  • B. Abrahamsen
    • 1
    Email author
  • T. van Staa
    • 2
    • 3
  • R. Ariely
    • 4
  • M. Olson
    • 5
  • C. Cooper
    • 6
    • 7
  1. 1.Department of Internal Medicine and EndocrinologyCopenhagen University Hospital GentofteHellerupDenmark
  2. 2.General Practice Research DatabaseLondonUK
  3. 3.Utrecht Institute for Pharmaceutical SciencesUtrecht UniversityUtrechtThe Netherlands
  4. 4.Novartis Pharmaceutical CorporationEast HanoverUSA
  5. 5.Novartis Pharma AGBaselSwitzerland
  6. 6.MRC Epidemiology Resource CentreUniversity of SouthamptonSouthamptonUK
  7. 7.NIHR Biomedical Research Unit in Musculoskeletal SciencesUniversity of OxfordOxfordUK

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