Osteoporosis International

, Volume 22, Issue 9, pp 2439–2448 | Cite as

Mortality rates after incident non-traumatic fractures in older men and women

  • S. Morin
  • L. M. Lix
  • M. Azimaee
  • C. Metge
  • P. Caetano
  • W. D. Leslie
Original Article

Abstract

Summary

Non-traumatic fractures at typical osteoporotic sites are associated with increased mortality across all age groups, particularly in men. Furthermore, in certain age subgroups of women and men, this rate remained elevated beyond 5 years for fractures of the hip, vertebrae, humerus, and other sites.

Introduction

Increased mortality rates have been documented following non-traumatic hip, vertebral, and shoulder fractures. However, data are lacking as to the duration of excess mortality and whether there is increased mortality following fractures at other sites. We determined mortality up to 15 years following incident fractures at typical osteoporotic sites.

Methods

Using healthcare databases for the Province of Manitoba, Canada, we identified individuals 50 years and older with an incident non-traumatic fracture between 1986 and 2007. Each fracture case was matched to three fracture-free controls. Generalized linear models were used to test for trends in mortality and to estimate the relative risk for cases after adjusting for co-morbidity and living arrangements.

Results

During the study period, we identified 21,067 incident fractures in men followed by 10,724 (50.1%) deaths and 49,197 incident fractures in women followed by 22,018 deaths (44.8%). Seventy-six percent of the fractures were at sites other than the hip and vertebrae. After adjustment for age, number of co-morbidities, and level of dependence in living arrangements, the risk of death in cases, relative to controls, was increased in both sexes for hip, vertebral, humerus, wrist (in men only), and other fracture sites. Post-fracture mortality was higher in men than women. Relative mortality was the highest in the younger age groups across the spectrum of fracture sites.

Conclusions

Fractures at typical osteoporotic sites are associated with increased mortality across all age groups, particularly in men. Better understanding of factors associated with increased post-fracture mortality should inform the development of management strategies.

Keywords

Cohort study Fractures Mortality Osteoporosis 

Notes

Acknowledgments

We are indebted to Manitoba Health for providing data (HIPC 2008/2009-16). The results and conclusions are those of the authors, and no official endorsement by Manitoba Health is intended or should be inferred.

Source of funding and role of the sponsor

Amgen Canada provided a research grant to the authors but was not represented on the research team, did not have direct access to data, did not participate in the analyses, and was not involved in the preparation or publication of this manuscript.

Conflicts of interest

Suzanne Morin has acted as a consultant to Procter & Gamble, Sanofi-Aventis, Amgen, and Novartis; is part of a speaker bureau for Procter& Gamble, Sanofi-Aventis, Amgen, and Novartis; and has received research grant from Amgen Canada.

Lisa Lix has received research grant from Amgen Canada.

Mahmoud Azimaee has nothing to declare.

Colleen Metge has received research grant from Amgen Canada.

Patricia Caetano has received research grant from Amgen Canada.

William Leslie is part of a speaker bureau and has received unrestricted research grants from Merck Frosst Canada, has received research honoraria and unrestricted educational grants from Sanofi-Aventis and Procter & Gamble Pharmaceuticals Canada, has received research grants from Novartis and Amgen Canada, has received unrestricted educational grants from Genzyme Canada, and is a member of the following advisory boards: Genzyme Canada, Novartis, and Amgen Canada.

References

  1. 1.
    Sambrook P, Cooper C (2006) Osteoporosis. Lancet 367:2010–2018PubMedCrossRefGoogle Scholar
  2. 2.
    Center JR, Nguyen TV, Schneider D, Sambrook PN, Eisman JA (1999) Mortality after all major types of osteoporotic fracture in men and women: an observational study. Lancet 353:878–882PubMedCrossRefGoogle Scholar
  3. 3.
    Adachi JD, Ioannidis G, Pickard L, Berger C, Prior JC, Joseph L et al (2003) The association between osteoporotic fractures and health-related quality of life as measured by the Health Utilities Index in the Canadian Multicentre Osteoporosis Study (CaMos). Osteoporos Int 14:895–904PubMedCrossRefGoogle Scholar
  4. 4.
    Burge R, Dawson-Hughes B, Solomon DH, Wong JB, King A, Tosteson A (2007) Incidence and economic burden of osteoporosis-related fractures in the United States, 2005–2025. J Bone Miner Res 22:465–475PubMedCrossRefGoogle Scholar
  5. 5.
    Johnell O, Kanis JA, Oden A, Sernbo I, Redlund-Johnell I, Petterson C et al (2004) Mortality after osteoporotic fractures. Osteoporos Int 15:38–42PubMedCrossRefGoogle Scholar
  6. 6.
    Ioannidis G, Papaioannou A, Hopman WM, Akhtar-Danesh N, Anastassiades T, Pickard L et al (2009) Relation between fractures and mortality: results from the Canadian Multicentre Osteoporosis Study. CMAJ 181:265–271PubMedCrossRefGoogle Scholar
  7. 7.
    Cauley JA, Thompson DE, Ensrud KC, Scott JC, Black D (2000) Risk of mortality following clinical fractures. Osteoporos Int 11:556–561PubMedCrossRefGoogle Scholar
  8. 8.
    Vestergaard P, Rejnmark L, Mosekilde L (2009) Loss of life years after a hip fracture. Acta Orthop 80:525–530PubMedCrossRefGoogle Scholar
  9. 9.
    Abrahamsen B, van Staa T, Ariely R, Olson M, Cooper C (2009) Excess mortality following hip fracture: a systematic epidemiological review. Osteoporos Int 20:1633–1650PubMedCrossRefGoogle Scholar
  10. 10.
    Bliuc D, Nguyen ND, Milch VE, Nguyen TV, Eisman JA, Center JR (2009) Mortality risk associated with low-trauma osteoporotic fracture and subsequent fracture in men and women. JAMA 301:513–521PubMedCrossRefGoogle Scholar
  11. 11.
    Lix LM, Yogendran MS, Leslie WD, Shaw SY, Baumgartner R, Bowman C et al (2008) Using multiple data features improved the validity of osteoporosis case ascertainment from administrative databases. J Clin Epidemiol 61:1250–1260PubMedCrossRefGoogle Scholar
  12. 12.
    Bolton JM, Metge C, Lix L, Prior H, Sareen J, Leslie WD (2008) Fracture risk from psychotropic medications: a population-based analysis. J Clin Psychopharmacol 28:384–391PubMedCrossRefGoogle Scholar
  13. 13.
    Demeter S, Reed M, Lix L, MacWilliam L, Leslie WD (2005) Socioeconomic status and the utilization of diagnostic imaging in an urban setting. CMAJ 173:1173–1177PubMedCrossRefGoogle Scholar
  14. 14.
    Kanis JA, Oden A, Johnell O, Jonsson B, De Laet C, Dawson A (2001) The burden of osteoporotic fractures: a method for setting intervention thresholds. Osteoporos Int 12:417–427PubMedCrossRefGoogle Scholar
  15. 15.
    Bessette L, Ste-Marie LG, Jean S, Davison KS, Beaulieu M, Baranci M et al (2008) The care gap in diagnosis and treatment of women with a fragility fracture. Osteoporos Int 19:79–86PubMedCrossRefGoogle Scholar
  16. 16.
    Curtis JR, Mudano AS, Solomon DH, Xi J, Melton ME, Saag KG (2009) Identification and validation of vertebral compression fractures using administrative claims data. Med Care 47:69–72PubMedCrossRefGoogle Scholar
  17. 17.
    Mackey DC, Lui LY, Cawthon PM, Bauer DC, Nevitt MC, Cauley JA et al (2007) High-trauma fractures and low bone mineral density in older women and men. JAMA 298:2381–2388PubMedCrossRefGoogle Scholar
  18. 18.
    Curtis JR, Taylor AJ, Matthews RS, Ray MN, Becker DJ, Gary LC et al (2009) “Pathologic” fractures: should these be included in epidemiologic studies of osteoporotic fractures? Osteoporos Int 20:1969–1972PubMedCrossRefGoogle Scholar
  19. 19.
    Becker C, Crow S, Toman J, Lipton C, McMahon D, Macaulay W et al (2006) Characteristics of elderly patients admitted to an urban tertiary care hospital with osteoporotic fractures: correlations with risk factors, fracture type, gender and ethnicity. Osteoporos Int 17:410–416PubMedCrossRefGoogle Scholar
  20. 20.
    Papaioannou A, Joseph L, Ioannidis G, Berger C, Anastassiades T, Brown JP et al (2005) Risk factors associated with incident clinical vertebral and nonvertebral fractures in postmenopausal women: the Canadian Multicentre Osteoporosis Study (CaMos). Osteoporos Int 16:568–578PubMedCrossRefGoogle Scholar
  21. 21.
    Kannegaard PN, van der MS, Eiken P, Abrahamsen B (2010) Excess mortality in men compared with women following a hip fracture. National analysis of comedications, comorbidity and survival. Age Ageing 39:203–209PubMedCrossRefGoogle Scholar
  22. 22.
    Barker WH, Zimmer JG, Hall WJ, Ruff BC, Freundlich CB, Eggert GM (1994) Rates, patterns, causes, and costs of hospitalization of nursing home residents: a population-based study. Am J Public Health 84:1615–1620PubMedCrossRefGoogle Scholar
  23. 23.
    McCann M, O'Reilly D, Cardwell C (2009) A Census-based longitudinal study of variations in survival amongst residents of nursing and residential homes in Northern Ireland. Age Ageing 38:711–717PubMedCrossRefGoogle Scholar
  24. 24.
    Smith NS, Weiner JP (1994) Applying population-based case mix adjustment in managed care: the Johns Hopkins Ambulatory Care Group system. Manag Care Q 2:21–34PubMedGoogle Scholar
  25. 25.
    Leslie WD, Derksen S, Prior HJ, Lix LM, Metge C, O'neil J (2006) The interaction of ethnicity and chronic disease as risk factors for osteoporotic fractures: a comparison in Canadian Aboriginals and non-Aboriginals. Osteoporos Int 17:1358–1368PubMedCrossRefGoogle Scholar
  26. 26.
    McCulloch CE, Searle SR (2001) Generalized, linear, and mixed models. Wiley, New YorkGoogle Scholar
  27. 27.
    Farahmand BY, Michaelsson K, Ahlbom A, Ljunghall S, Baron JA (2005) Survival after hip fracture. Osteoporos Int 16:1583–1590PubMedCrossRefGoogle Scholar
  28. 28.
    Metge CJ, Leslie WD, Manness LJ, Yogendran M, Yuen CK, Kvern B (2008) Postfracture care for older women: gaps between optimal care and actual care. Can Fam Physician 54:1270–1276PubMedGoogle Scholar
  29. 29.
    Roos LL, Walld RK, Romano PS, Roberecki S (1996) Short-term mortality after repair of hip fracture. Do Manitoba elderly do worse? Med Care 34:310–326PubMedCrossRefGoogle Scholar
  30. 30.
    Kanis JA, Oden A, Johnell O, De Laet C, Jonsson B, Oglesby AK (2003) The components of excess mortality after hip fracture. Bone 32:468–473PubMedCrossRefGoogle Scholar
  31. 31.
    Kanis JA, Oden A, Johnell O, De Laet C, Jonsson B (2004) Excess mortality after hospitalisation for vertebral fracture. Osteoporos Int 15:108–112PubMedCrossRefGoogle Scholar
  32. 32.
    Lyles KW, Colon-Emeric CS, Magaziner JS, Adachi JD, Pieper CF, Mautalen C et al (2007) Zoledronic acid and clinical fractures and mortality after hip fracture. N Engl J Med 357:1799–1809PubMedCrossRefGoogle Scholar
  33. 33.
    Colon-Emeric CS, Mesenbrink P, Lyles KW, Pieper CF, Boonen S, Delmas P et al (2009) Potential mediators of the mortality reduction with zoledronic acid after hip fracture. J Bone Miner Res 25:91–97CrossRefGoogle Scholar
  34. 34.
    Bolland MJ, Grey AB, Gamble GD, Reid IR (2010) Effect of osteoporosis treatment on mortality: a meta-analysis. J Clin Endocrinol Metab 95:1174–1181PubMedCrossRefGoogle Scholar
  35. 35.
    Brown JP, Josse RG (2002) 2002 clinical practice guidelines for the diagnosis and management of osteoporosis in Canada. CMAJ 167:S1–S34PubMedGoogle Scholar
  36. 36.
    Rahmani P, Morin S (2009) Prevention of osteoporosis-related fractures among postmenopausal women and older men. CMAJ 181:815–820PubMedCrossRefGoogle Scholar
  37. 37.
    MacLean C, Newberry S, Maglione M, McMahon M, Ranganath V, Suttorp M et al (2008) Systematic review: comparative effectiveness of treatments to prevent fractures in men and women with low bone density or osteoporosis. Ann Intern Med 148:197–213PubMedGoogle Scholar
  38. 38.
    Tosteson AN, Burge RT, Marshall DA, Lindsay R (2008) Therapies for treatment of osteoporosis in US women: cost-effectiveness and budget impact considerations. Am J Manag Care 14:605–615PubMedGoogle Scholar
  39. 39.
    Giangregorio L, Papaioannou A, Cranney A, Zytaruk N, Adachi JD (2006) Fragility fractures and the osteoporosis care gap: an international phenomenon. Semin Arthritis Rheum 35:293–305PubMedCrossRefGoogle Scholar
  40. 40.
    Levasseur R, Sabatier JP, Guilcher C, Guaydier-Souquieres G, Costentin-Pignol V, Jean-Jacques PY et al (2007) Medical management of patients over 50 years admitted to orthopedic surgery for low-energy fracture. Joint Bone Spine 74:160–165PubMedCrossRefGoogle Scholar

Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2010

Authors and Affiliations

  • S. Morin
    • 1
  • L. M. Lix
    • 2
  • M. Azimaee
    • 3
  • C. Metge
    • 3
  • P. Caetano
    • 3
  • W. D. Leslie
    • 3
  1. 1.Division of General Internal MedicineMcGill University Health Center (MUHC)MontrealCanada
  2. 2.University of SaskatchewanSaskatoonCanada
  3. 3.University of ManitobaWinnipegCanada

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