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Osteoporosis International

, Volume 27, Issue 10, pp 2945–2953 | Cite as

Hip fracture, mortality risk, and cause of death over two decades

  • M. von Friesendorff
  • F. E. McGuigan
  • A. Wizert
  • C. Rogmark
  • A. H. Holmberg
  • A. D. Woolf
  • K. AkessonEmail author
Original Article

Abstract

Summary

Men and women with hip fracture have higher short-term mortality. This study investigated mortality risk over two decades post-fracture; excess mortality remained high in women up to 10 years and in men up to 20 years. Cardiovascular disease (CVD) and pneumonia were leading causes of death with a long-term doubling of risk.

Introduction

Hip fractures are associated with increased mortality, particularly short term. In this study with a two-decade follow-up, we examined mortality and cause of death compared to the background population.

Methods

We followed 1013 hip fracture patients and 2026 matched community controls for 22 years. Mortality, excess mortality, and cause of death were analyzed and stratified for age and sex. Hazard ratio (HR) was estimated by Cox regression. A competing risk model was fitted to estimate HR for common causes of death (CVD, cancer, pneumonia) in the short and long term (>1 year).

Results

For both sexes and at all ages, mortality was higher in hip fracture patients across the observation period with men losing most life years (p < 0.001). Mortality risk was higher for up to 15 years (women (risk ratio (RR) 1.9 [95 % confidence interval (CI) 1.7–2.1]); men (RR 2.8 [2.2–3.5])) and until end of follow-up ((RR 1.8 [1.6–2.0]); (RR 2.7 [2.1–3.3])). Excess mortality by time intervals, censored for the first year, was evident in women (<80 years, up to 10 years; >80 years, for 5 years) and in men <80 years throughout. CVD and pneumonia were predominant causes of death in men and women with an associated higher risk in all age groups. Pneumonia caused excess mortality in men over the entire observation period.

Conclusion

In a remaining lifetime perspective, all-cause and excess mortality after hip fracture was higher even over two decades of follow-up. CVD and pneumonia reduce life expectancy for the remaining lifetime and highlights the need to further improve post-fracture management.

Keywords

Age Cause of death Hip fracture Mortality Sex 

Notes

Acknowledgments

This work was supported by grants from the Swedish Research Council (K2009-53X-14691-07-3, K2010-77PK-21362-01-2); FAS (Grant 2007–2125); Greta and Johan Kock Foundation; A Påhlsson Foundation; A Österlund Foundation; King Gustav V and Queen Victoria Foundation; Malmö University Hospital Research Foundation; Research and Development Council of Region Skåne, Sweden; and the Swedish Medical Society. We thank Professor Jonas Ranstam and Mr Jan-Åke Nilsson for statistical advice and Dr Jack Besjakov for access to radiography files.

Compliance with ethical standards

Conflicts of interest

None.

Supplementary material

198_2016_3616_MOESM1_ESM.doc (76 kb)
Supplementary Table 1 (DOC 75 kb)
198_2016_3616_MOESM2_ESM.doc (123 kb)
Supplementary Table 2 (DOC 123 kb)

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Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2016

Authors and Affiliations

  • M. von Friesendorff
    • 1
    • 2
  • F. E. McGuigan
    • 1
    • 2
  • A. Wizert
    • 3
  • C. Rogmark
    • 1
    • 2
  • A. H. Holmberg
    • 1
    • 2
  • A. D. Woolf
    • 4
  • K. Akesson
    • 1
    • 2
    Email author
  1. 1.Department of Clinical Sciences Malmö, Clinical and Molecular Osteoporosis Research UnitLund UniversityMalmöSweden
  2. 2.Department of Orthopedics MalmöSkåne University HospitalMalmöSweden
  3. 3.ERC Syd - Epidemiology and Register Centre SouthSkåne University HospitalLundSweden
  4. 4.Department of Rheumatology Royal Cornwall HospitalTruroUK

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