Mortality rates after incident non-traumatic fractures in older men and women
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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.
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.
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.
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.
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.
KeywordsCohort study Fractures Mortality Osteoporosis
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.
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