Calcified Tissue International

, Volume 78, Issue 2, pp 72–77 | Cite as

Mortality Rates of Patients with a Hip Fracture in a Southwestern District of Greece: Ten-Year Follow-Up with Reference to the Type of Fracture

  • A. Karagiannis
  • E. PapakitsouEmail author
  • K. Dretakis
  • A. Galanos
  • P. Megas
  • E. Lambiris
  • G. P. Lyritis


Increased mortality after a hip fracture has been associated with age, sex, and comorbidity. In order to estimate the long-term mortality with reference to hip fracture type, we followed 499 patients older than 60 years who had been treated surgically for a unilateral hip fracture for 10 years. At admission, patients with femoral neck fractures (n = 172) were 2 years younger than intertrochanteric patients (77.6 ± 7.7 [SD] vs. 79.9 ± 7.4 [SD], P = 0.001) and had a greater prevalence of heart failure (57% vs. 40.3%, P = 0.03). Similar mortality rates were observed at 1 year in both types of fracture (17.9% vs. 11.3%, log rank test P = 0.112). Mortality rates were significantly higher for intertrochanteric fractures at 5 years (48.8% vs. 34.7%, P = 0.01) and 10 years (76% vs. 58%, P = 0.001). Patients 60–69 years old with intertrochanteric fractures had significantly higher 10-year mortality than patients of similar age with femoral neck fractures (P = 0.008), while there was no difference between the groups aged 70–79 (P > 0.3) and 80–89 (P = 0.07). Women were less likely to die in 5 years (relative risk [RR] = 0.57, 95% confidence interval [CI] 0.41–0.79, P = 0.0007) and 10 years (RR = 0.65, 95% CI 0.49–0.85, P = 0.002). Age, sex, the type of fracture, and the presence of heart failure were independent predictors of 10-year mortality (Cox regression model P < 0.0001). The intertrochanteric type was independently associated with 1.37 (95% CI 1.03–1.83) times higher probability of death at 10 years (P = 0.002). In conclusion, the type of fracture is an independent predictor of long-term mortality in patients with hip fractures, and the intertrochanteric type yields worse prognosis.


Hip fracture Long-term mortality Type of fracture 


  1. 1.
    Dahl E (1980) Mortality and life expectancy after hip fractures. Acta Orthop Scand 51:163–170PubMedGoogle Scholar
  2. 2.
    Eiskjaer S, Ostgard SE, Jakobsen BW, Jensen J, Lucht U (1992) Years of potential life lost after hip fracture among postmenopausal women. Acta Orthop Scand 63:293–296PubMedGoogle Scholar
  3. 3.
    Schroder HM, Erlandsen M (1993) Age and sex as determinants of mortality after hip fracture: 3,985 patients followed for 2.5–18.5 years. J Orthop Trauma 7:525–531PubMedGoogle Scholar
  4. 4.
    Cooper C (1997) The crippling consequences of fractures and their impact on quality of life. Am J Med 103:12S–17SCrossRefPubMedGoogle Scholar
  5. 5.
    Luthje P, Karajan M, Naomi I, Antiviral S, Avikainen V (1995) Four-year survival after hip fractures — an analysis in two Finnish health care regions. Ann Chir Gynaecol 84:395–401PubMedGoogle Scholar
  6. 6.
    Empana JP, Dargent-Molina P, Breart G; EPIDOS Group (2004) Effect of hip fracture on mortality in elderly women: the EPIDOS prospective study. J Am Geriatr Soc 52:685–690CrossRefPubMedGoogle Scholar
  7. 7.
    Johnell O, Kanis JA, Oden A, Sernbo I, Redlund-Johnell I, Petterson C, De Laet C, Jonsson B (2004) Mortality after osteoporotic fractures. Osteoporos Int 15:38–42PubMedGoogle Scholar
  8. 8.
    Cooper C, Atkinson EJ, Jacobsen SJ, O’Fallon WM, Melton LJ 3rd (1993) Population-based study of survival after osteoporotic fractures. Am J Epidemiol 137:1001–1005PubMedGoogle Scholar
  9. 9.
    Center JR, Nguyen TV, Schneider D, Sambrook PN, Eisman JA (1999) Mortality after all major types of osteoporotic fractures in men and women: an observational study. Lancet 353:878–882CrossRefPubMedGoogle Scholar
  10. 10.
    Cauley JA, Thompson DE, Ensrud KC, Scott JC, Black D (2000) Risk of mortality following clinical fractures. Osteoporos Int 11:556–561CrossRefPubMedGoogle Scholar
  11. 11.
    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
  12. 12.
    Browner WS, Pressman AR, Nevitt MC, Cummings SR (1996) Mortality following fractures in older women. The Study of Osteoporotic Fractures. Arch Intern Med 156:1521–1525CrossRefPubMedGoogle Scholar
  13. 13.
    Paspati I, Galanos A, Lyritis GP (1998) Hip fracture epidemiology in Greece during 1977–1992. Calcif Tissue Int 62:542–547CrossRefPubMedGoogle Scholar
  14. 14.
    Jacobsen SJ, Goldberg J, Miles TP, Brody JA, Stiers W, Rimm AA (1992) Race and sex differences in mortality following fracture of the hip. J Public Health 82:1147–1150Google Scholar
  15. 15.
    Poor G, Atkinson EJ, O’Fallon WM, Melton LJ 3rd (1995) Determinants of reduced survival following hip fractures in men. Clin Orthop Relat Res 319:260–265PubMedGoogle Scholar
  16. 16.
    Meyer HE, Tverdal A, Falch JA, Pedersen JI (2000) Factors associated with mortality after hip fracture. Osteoporos Int 11:228–232CrossRefPubMedGoogle Scholar
  17. 17.
    Forsen L, Sogaard AJ, Meyer HE, Edna TH, Kopjar B (1999) Survival after hip fracture: short- and long-term excess mortality according to age and gender. Osteopors Int 10:73–78Google Scholar
  18. 18.
    Fox KM, Magaziner J, Hebel JR, Kenzora JE, Kashner TM (1999) Intertrochanteric versus femoral neck hip fractures: differential characteristics, treatment and sequelae. J Gerontol A Biol Sci Med Sci 54:M635–M640PubMedGoogle Scholar
  19. 19.
    Keene GS, Parker MJ, Pryor GA (1993) Mortality and morbidity after hip fractures. BMJ 307:1248–1250PubMedGoogle Scholar
  20. 20.
    Kanis JA, Johnell O, De Laet C, Jonsson B, Oden A, Ogelsby AK (2002) International variations in hip fracture probabilities: implications for risk assessment. J Bone Miner Res 17:1237–1244PubMedGoogle Scholar
  21. 21.
    Charopoulos J, Paspati I, Galanos A, Lyritis GP (2004) Secular trends of hip fracture epidemiology in Greece during 1977-2002. J Musculoskel Neuron Interact 4:222Google Scholar
  22. 22.
    General Secretariat of National Statistical Service of Greece. TS_28_00 _11_Y.htm.
  23. 23.
    Stavrou ZP, Erginousakis DA, Loizides AA, Tzevelekos SA, Papagiannakos KJ (1997) Mortality and rehabilitation following hip fracture. A study of 202 elderly patients. Acta Orthop Scand Suppl 275:89–91PubMedGoogle Scholar
  24. 24.
    Dretakis KE (1996) Study on the bilateral noncontemporary fractures of the upper femur. PhD dissertation, University of Crete, Heraklion Google Scholar
  25. 25.
    Magaziner J, Simonsick EM, Kashner TM, Hebel JR, Kenzora JE (1989) Survival experience of aged hip fracture patients. Am J Public Health 79:274–278PubMedGoogle Scholar
  26. 26.
    Aharonoff GB, Koval KJ, Skovron ML, Zuckerman JD (1997) Hip fractures in the elderly: predictors of one year mortality. J Orthop Trauma 11:162–165CrossRefPubMedGoogle Scholar
  27. 27.
    Svensson O, Stromberg L, Ohlen G, Lindgren U (1996) Prediction of the outcome after hip fracture in elderly patients. J Bone Joint Surg Br 78:115–118PubMedGoogle Scholar
  28. 28.
    Alegre-Lopez J, Cordero-Guevara J, Alonso-Valdivielso JL, Fernandez-Melon J (2005) Factors associated with mortality and functional disability after hip fracture: an inception cohort study. Osteoporos Int 16:729–736PubMedGoogle Scholar
  29. 29.
    Olmeda A, Greco F, Timar J, Malgaroli E (1995) Death rate in patients submitted to the surgical treatment of fractures of the proximal femur. Chir Organi Mov 80:179–181PubMedGoogle Scholar
  30. 30.
    Trombetti A, Herrmann F, Hoffmeyer P, Schurch MA, Bonjour JP, Rizzoli R (2002) Survival and potential years of life lost after hip fracture in men and age-matched women. Osteoporos Int 13:731–737CrossRefPubMedGoogle Scholar
  31. 31.
    Lu-Yao GL, Baron JA, Barrett JA, Fisher ES (1994) Treatment and survival among elderly Americans with hip fractures: a population-based study. Am J Public Health 84:1287–1291PubMedGoogle Scholar
  32. 32.
    Marottoli RA, Berkman LF, Leo-Summers L, Cooney LM (1994) Predictors of mortality and institutionalization after hip fracture: The New Haven EPESE cohort. Am J Public Health 84:1807–1812PubMedGoogle Scholar
  33. 33.
    Cornwall R, Gilbert MS, Koval KJ, Strauss E, Siu AL (2004) Functional outcomes and mortality vary among different types of hip fractures: a function of patient characteristics. Clin Orthop Relat Res 425:64–71PubMedGoogle Scholar
  34. 34.
    Elmerson S, Zetterberg C, Anderson GB (1988) Ten year survival after fracture of the proximal end of the femur. Gerontology 34:186-191PubMedGoogle Scholar
  35. 35.
    Jalovaara P, Virkkunen H (1991) Quality of life after primary hemiarthroplasty for femoral neck fracture. 6 years follow-up of 185 patients. Acta Orthop Scand 62:208–217PubMedGoogle Scholar
  36. 36.
    Willig R, Keinänen-Kiukaaniemi S, Jalovaara P (2001) Mortality and quality of life after trochanteric hip fracture. Public Health 115:323–327CrossRefPubMedGoogle Scholar
  37. 37.
    Baudoin C, Fardellone P, Sebert JL (1993) Effect of sex and age on the ratio of cervical to trochanteric hip fracture: a meta-analysis of 16 reports on 36,451 cases. Acta Orthop Scand 64:647–653PubMedGoogle Scholar
  38. 38.
    Mautalen CA, Vega EM (1993) Different characteristics of cervical and trochanteric hip fractures. Osteoporos Int Suppl 1:102–105Google Scholar
  39. 39.
    Koval KJ, Aharonoff GB, Rokito AS, Lyon T, Zuckerman JD (1996) Patients with femoral neck and intetrochanteric fractures. Are they the same? Clin Orthop 330:166–172PubMedGoogle Scholar
  40. 40.
    Karlsson MK, Johnell O, Nilsson BE, Sernbo I, Obrant KJ (1993) Bone mineral mass in hip fracture patients. Bone 14:161–165CrossRefPubMedGoogle Scholar
  41. 41.
    Nakamura N, Kyou T, Takaoka K, Ohzono K, Ono K (1992) Bone mineral density in the proximal femur and hip fracture type in the elderly. J Bone Miner Res 7:755–759PubMedGoogle Scholar
  42. 42.
    Mautalen CA, Vega EM, Einhorn TA (1996) Are the etiologies of cervical and trochanteric hip fractures different? Bone 18 (suppl 3):133S–137SPubMedGoogle Scholar
  43. 43.
    White BL, Fisher WD, Laurin CA (1987) Rate of mortality for elderly patients after the fracture of the hip in the 1980’s. J Bone Joint Surg Am 69:1335–1340PubMedGoogle Scholar
  44. 44.
    Michel JP, Klopfenstein C, Hoffmeyer P, Stern R, Grab B (2002) Hip fracture surgery: is the preoperative American Society of Anaesthesiologists (ASA) score a predictor of functional outcome? Aging Clin Exp Res 14:389–394PubMedGoogle Scholar
  45. 45.
    Richmond J, Aharonoff GB, Zuckerman JD, Koval KJ (2003) Mortality risk after hip fracture. J Orthop Trauma 17:53–56CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, Inc. 2006

Authors and Affiliations

  • A. Karagiannis
    • 1
  • E. Papakitsou
    • 2
    Email author
  • K. Dretakis
    • 2
  • A. Galanos
    • 2
  • P. Megas
    • 1
  • E. Lambiris
    • 1
  • G. P. Lyritis
    • 2
  1. 1.Orthopedic DepartmentUniversity Hospital, University of PatrasGreece
  2. 2.Laboratory for the Research of the Musculoskeletal System “Th. Garofalidis,”University of AthensGreece

Personalised recommendations