Advertisement

Osteoporosis International

, Volume 28, Issue 3, pp 881–887 | Cite as

Excess mortality following hip fracture: impact of self-perceived health, smoking, and body mass index. A NOREPOS study

  • S. M. SolbakkenEmail author
  • H. E. Meyer
  • H. Stigum
  • A. J. Søgaard
  • K. Holvik
  • J. H. Magnus
  • T. K. Omsland
Original Article

Abstract

Summary

Self-perceived health, smoking, and body mass index measured years before the hip fracture predicted excess post-hip fracture mortality, and even hip fracture patients with the most favorable levels of these risk factors had higher mortality than subjects who did not fracture.

Introduction

This study aimed to investigate the impact of pre-fracture self-perceived health, smoking, and body mass index (BMI) on excess post-hip fracture mortality using matched peers without hip fracture as reference.

Methods

The study was based on the Cohort of Norway (CONOR) consisting of 10 regional health studies (1994–2003) and the NOREPOS hip fracture database (1994–2008). A matched cohort design was used to compare survival between hip fracture patients and subjects without fracture (matched on gender, age at participation in CONOR, and study site). Subjects aged ≥60 years were included. Hazard ratios were estimated using stratified Cox regression. Age-standardized mortality was also calculated.

Results

Overall, hip fracture patients (N = 3177) had a 2.26-fold (95 % CI 2.13, 2.40) increased mortality compared to matched subjects (N = 20,282). The highest excess mortality was found in hip fracture patients reporting poor health (HR 4.08, 95 % CI 3.17, 5.26) and daily smoking (HR 3.25, 95 % CI 2.89, 3.66) and in patients with BMI <18.5 (HR 3.07, 95 % CI 2.11, 4.47) prior to the fracture. However, excess mortality was also observed in hip fracture patients in all other categories of BMI, self-perceived health, and smoking.

Conclusions

Information on self-perceived health, smoking, and BMI collected years before hip fracture predicted excess post-hip fracture mortality, and even hip fracture patients with the most favorable levels of these risk factors had higher mortality than the matched subjects who did not fracture. This suggests that both pre-fracture health status and factors related to the hip fracture itself might affect post-hip fracture mortality.

Keywords

Body mass index Excess mortality Hip fracture Self-perceived health Smoking 

Notes

Acknowledgments

The authors wish to acknowledge the services of the Cohort of Norway (CONOR), the contributing research centers delivering data to CONOR. The authors are deeply grateful to Tomislav Dimoski (The Norwegian Knowledge Centre for the Health Services), the Statistics Norway, and the staff at the Department of Pharmacoepidemiology (Norwegian Institute of Public Health) contributing to the collection and encryption of the hip fracture data. Professor Aage Tverdal at the Norwegian Institute of Public Health has generously managed the original project.

Compliance with ethical standards

Ethics statement

The Regional Committee for Medical and Health Research Ethics, the Norwegian Data Protection Authority, The Directorate of Health, the National Registry, and Statistics Norway have approved the study and the linkages of data.

Conflicts of interest

None.

References

  1. 1.
    Empana J-P, Dargent-Molina P, Bréart G, for the EG (2004) Effect of hip fracture on mortality in elderly women: the EPIDOS prospective study. J Am Geriatr Soc 52:685–690CrossRefPubMedGoogle Scholar
  2. 2.
    Farahmand B, Michaëlsson K, Ahlbom A, Ljunghall S, Baron J (2005) Survival after hip fracture. Osteoporos Int 16:1583–1590CrossRefPubMedGoogle Scholar
  3. 3.
    Forsén L, Søgaard AJ, Meyer HE, Edna TH, Kopjar B (1999) Survival after hip fracture: short- and long-term excess mortality according to age and gender. Osteoporos Int 10:73–78CrossRefPubMedGoogle Scholar
  4. 4.
    Grønskag AB, Romundstad P, Forsmo S, Langhammer A, Schei B (2012) Excess mortality after hip fracture among elderly women in Norway. Osteoporos Int 23:1807–1811CrossRefPubMedGoogle Scholar
  5. 5.
    Haentjens P, Magaziner J, Colón-Emeric CS, Vanderschueren D, Milisen K, Velkeniers B, Boonen S (2010) Meta-analysis: excess mortality after hip fracture among older women and men. Ann Intern Med 152:380–390CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Hung L-W, Tseng W-J, Huang G-S, Lin J (2014) High short-term and long-term excess mortality in geriatric patients after hip fracture: a prospective cohort study in Taiwan. BMC Musculoskelet Disord 15:151–151CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Omsland TK, Emaus N, Tell GS et al (2014) Mortality following the first hip fracture in Norwegian women and men (1999–2008). A NOREPOS study. Bone 63:81–86CrossRefPubMedGoogle Scholar
  8. 8.
    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 301:513–521CrossRefPubMedGoogle Scholar
  9. 9.
    Hu F, Jiang C, Shen J, Tang P, Wang Y (2012) Preoperative predictors for mortality following hip fracture surgery: a systematic review and meta-analysis. Injury 43:676–685CrossRefPubMedGoogle Scholar
  10. 10.
    Kim S-M, Moon Y-W, Lim S-J, Yoon B-K, Min Y-K, Lee D-Y, Park Y-S (2012) Prediction of survival, second fracture, and functional recovery following the first hip fracture surgery in elderly patients. Bone 50:1343–1350CrossRefPubMedGoogle Scholar
  11. 11.
    Kirkland LL, Kashiwagi DT, Burton MC, Cha S, Varkey P (2011) The Charlson comorbidity index score as a predictor of 30-day mortality after hip fracture surgery. Am J Med Qual 26:461–467CrossRefPubMedGoogle Scholar
  12. 12.
    Schaller F, Sidelnikov E, Theiler R et al (2012) Mild to moderate cognitive impairment is a major risk factor for mortality and nursing home admission in the first year after hip fracture. Bone 51:347–352CrossRefPubMedGoogle Scholar
  13. 13.
    Stewart NA, Chantrey J, Blankley SJ, Boulton C, Moran CG (2011) Predictors of 5 year survival following hip fracture. Injury 42:1253–1256CrossRefPubMedGoogle Scholar
  14. 14.
    Söderqvist A, Ekström W, Ponzer S, Pettersson H, Cederholm T, Dalén N, Hedström M, Tidermark J (2009) Prediction of mortality in elderly patients with hip fractures: a two-year prospective study of 1,944 patients. Gerontology 55:496–504CrossRefPubMedGoogle Scholar
  15. 15.
    Bliemel C, Sielski R, Doering B, Dodel R, Balzer-Geldsetzer M, Ruchholtz S, Buecking B (2016) Pre-fracture quality of life predicts 1-year survival in elderly patients with hip fracture—development of a new scoring system. Osteoporos Int 27:1979–1987CrossRefPubMedGoogle Scholar
  16. 16.
    Cauley JA, Thompson DE, Ensrud KC, Scott JC, Black D (2000) Risk of mortality following clinical fractures. Osteoporos Int 11:556–561CrossRefPubMedGoogle Scholar
  17. 17.
    Tosteson ANA, Gottlieb DJ, Radley D, Fisher ES, Melton LJ (2007) Excess mortality following hip fracture: the role of underlying health status. Osteoporosis international: a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA 18:1463–1472CrossRefGoogle Scholar
  18. 18.
    Vestergaard P, Rejnmark L, Mosekilde L (2007) Increased mortality in patients with a hip fracture-effect of pre-morbid conditions and post-fracture complications. Osteoporos Int 18:1583–1593CrossRefPubMedGoogle Scholar
  19. 19.
    Berger N, Van der Heyden J, Van Oyen H (2015) The global activity limitation indicator and self-rated health: two complementary predictors of mortality. Archives of Public Health 73:25CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    DeSalvo K, Bloser N, Reynold K, He J, Muntner P (2006) Mortality prediction with a single general self-rated health question. A meta-analysis. J Gen Intern Med 21:267–275CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Idler E, Benyamini Y (1997) Self-rated health and mortality: a review of twenty-seven community studies. J Health Soc Behav 38:21–37CrossRefPubMedGoogle Scholar
  22. 22.
    Singh-Manoux A, Gueguen A, Martikainen P, Ferre J, Marmot M, Shipley M (2007) Self-rated health and mortality: short-and long-term associations in the Whitehall II study. Psychosom Med 69:138–143CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Prieto-Alhambra D, Premaor MO, Avilés FF, Castro AS, Javaid MK, Nogués X, Arden NK, Cooper C, Compston JE, Diez-Perez A (2014) Relationship between mortality and BMI after fracture: a population-based study of men and women aged ≥40 Years. J Bone Miner Res 29:1737–1744CrossRefPubMedGoogle Scholar
  24. 24.
    Naess O, Sogaard AJ, Arnesen E et al (2008) Cohort profile: cohort of Norway (CONOR). Int J Epidemiol 37:481–485CrossRefPubMedGoogle Scholar
  25. 25.
    Omsland TK, Holvik K, Meyer HE et al (2012) Hip fractures in Norway 1999-2008: time trends in total incidence and second hip fracture rates: a NOREPOS study. Eur J Epidemiol 27:807–814CrossRefPubMedGoogle Scholar
  26. 26.
    Cummings P, McKnight B, Greenland S (2003) Matched cohort methods for injury research. Epidemiol Rev 25:43–50CrossRefPubMedGoogle Scholar
  27. 27.
    Abrahamsen B, van Staa T, Ariely R, Olson M, Cooper C (2009) Excess mortality following hip fracture: a systematic epidemiological review. Osteoporos Int 20:1633–1650CrossRefPubMedGoogle Scholar
  28. 28.
    Brozek W, Reichardt B, Kimberger O, Zwerina J, Dimai H, Kritsch D, Klaushofer K, Zwettler E (2014) Mortality after hip fracture in Austria 2008–2011. Calcif Tissue Int 95:257–266CrossRefPubMedGoogle Scholar
  29. 29.
    Meyer HE, Tverdal A, Falch JA, Pedersen JI (2000) Factors associated with mortality after hip fracture. Osteoporos Int 11:228–232CrossRefPubMedGoogle 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 32:468–473CrossRefPubMedGoogle Scholar
  31. 31.
    Lawrence VA, Hilsenbeck SG, Noveck H, Poses RM, Carson JL (2002) Medical complications and outcomes after hip fracture repair. Arch Intern Med 162:2053–2057CrossRefPubMedGoogle Scholar
  32. 32.
    Roche JJW, Wenn RT, Sahota O, Moran CG (2005) Effect of comorbidities and postoperative complications on mortality after hip fracture in elderly people: prospective observational cohort study. BMJ: British Medical Journal 331:1374–1374CrossRefPubMedGoogle Scholar
  33. 33.
    Rosencher N, Vielpeau C, Emmerich J, Fagnani F, Samama CM (2005) Venous thromboembolism and mortality after hip fracture surgery: the ESCORTE study1,2. J Thromb Haemost 3:2006–2014CrossRefPubMedGoogle Scholar
  34. 34.
    Moja L, Piatti A, Pecoraro V, Ricci C, Virgili G, Salanti G, Germagnoli L, Liberati A, Banfi G (2012) Timing matters in hip fracture surgery: patients operated within 48 Hours have better outcomes. A meta-analysis and meta-regression of over 190,000 patients. PLoS One 7:e46175CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2016

Authors and Affiliations

  1. 1.Institute of Health and Society, Department of Community MedicineUniversity of OsloOsloNorway
  2. 2.Norwegian Institute of Public HealthOsloNorway
  3. 3.Section for Leadership, Faculty of MedicineUniversity of OsloOsloNorway

Personalised recommendations