Osteoporosis International

, Volume 28, Issue 1, pp 161–168 | Cite as

The epidemiology of mortality after fracture in England: variation by age, sex, time, geographic location, and ethnicity

  • C. Klop
  • T. P. van Staa
  • C. CooperEmail author
  • N. C. Harvey
  • F. de Vries
Original Article



One-year mortality following a fracture was greater for men compared to women, varied markedly between regions in England with the lowest rates in the London region, and was higher among black women compared to white women. The excess in mortality did not change during the study period.


Fractures are associated with increased mortality. With the shift towards an increasingly elderly demography, and so increasing numbers of fractures, the impact of such events on mortality is of key public health importance. Therefore, we aimed to present up-to-date mortality rates following fracture in England.


This was a population-based study within the Clinical Practice Research Datalink, linked to death certificates (1 January 2001 to 31 December 2011). Subjects were followed from their first fracture (hip, wrist, humerus, clinical spine, ribs, or pelvis) until death for up to 1 year. Rate ratios (RRs) were estimated for 1-year mortality, stratified by sex, 5-year age categories, ethnicity, and geographical region. Excess mortality was presented as standardized mortality ratios (SMRs).


One-year mortality following fracture increased with age and was higher for men than women. Black women (RR 1.77; 95 % CI 1.00–3.12) and women of “other” ethnicity (RR 1.59, 95 % CI 1.16–2.16) were at higher risk of death when compared to white women. Mortality was higher among women in almost all regions when compared to the London region, with the highest risk in the East Midlands (37 % higher). The 1-year mortality risk was more than 3-fold higher after fracture as compared to the general population (adjusted SMR: 3.15, 95 % CI 3.09–3.26) and did not change during the study period. Major causes of death were neoplasms, respiratory diseases, and circulatory diseases.


This study provides up-to-date mortality outcomes following fracture in England and will aid allocation of healthcare provision to those at greatest need.


Comorbidity Epidemiology Mortality Osteoporosis 



The work was supported by a grant from the National Osteoporosis Society. This work was further supported by grants from the Medical Research Council, British Heart Foundation, Arthritis Research UK, National Institute for Health Research (NIHR) Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, and NIHR Musculoskeletal Biomedical Research Unit, University of Oxford.

Compliance with ethical standards

Conflicts of interest


Supplementary material

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Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2016

Authors and Affiliations

  1. 1.Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Faculty of ScienceUtrecht UniversityUtrechtThe Netherlands
  2. 2.Health eResearch Centre, Farr Institute for Health Informatics ResearchUniversity of ManchesterManchesterUK
  3. 3.MRC Lifecourse Epidemiology Unit, University of SouthamptonSouthampton General HospitalSouthamptonUK
  4. 4.NIHR Musculoskeletal Biomedical Research UnitUniversity of OxfordOxfordUK
  5. 5.NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation TrustSouthamptonUK
  6. 6.Department of Clinical Pharmacy and ToxicologyMaastricht University Medical Centre+MaastrichtThe Netherlands
  7. 7.Department of Epidemiology, Care and Public Health Research Institute (CAPHRI)Maastricht UniversityMaastrichtThe Netherlands

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