European Journal of Epidemiology

, Volume 23, Issue 11, pp 747–755 | Cite as

Fractures as predictors of excess mortality in the aged—A population-based study with a 12-year follow-up

  • Maarit PiirtolaEmail author
  • Tero Vahlberg
  • Minna Löppönen
  • Ismo Räihä
  • Raimo Isoaho
  • Sirkka-Liisa Kivelä


Introduction and objective The association between fractures and excess mortality in old age is ambiguous. The objective of this study was to analyze the long-term gender-specific association between fractures and mortality among older persons by controlling several survival related confounders. Methods A population-based prospective cohort study in the municipality of Lieto, south-western Finland. Data on health, health behaviour, fractures, and mortality in 482 men and 695 women aged 65 or older was collected from 1991 until 2002. The Cox Proportional Hazards regression model with fractures as time-dependent variables was used in the analyses. Results During the 12-year follow-up, 295 (25%) persons sustained at least one fracture. Sustaining any kind of fracture was related to excess mortality both in men (age-adjusted Hazards Ratio, HR 2.2, 95% confidence intervals, CI 1.6–3.1) and in women (HR 1.6, 95% CI 1.3–2.1). In the multivariate analyses, hip fractures in men (HR 8.1, 95% CI 4.4–14.9) and in women (HR 3.0, 95% CI 1.9–4.9), and proximal humerus fractures in men (HR 5.4, 95% CI 1.6–17.7) were related to increased mortality. Conclusion A hip fracture was a powerful independent predictor of long-term excess mortality in both genders but the risk in men was more than 2-fold compared to women. Proximal humerus fractures were associated with increased mortality in men. Actions to improve prevention, acute care and rehabilitation of fractures are needed in order to reduce excess mortality in older people.


Aged Comorbidity Follow-up Fracture Mortality Population-based 



Activities of daily living


Body mass index


Hazards ratio


Instrumental activities of daily living


International classification of diseases 10th version




Mini-mental state examination


Standard deviation


Zung self-rating depression scale

95% CI

95% Confidence Interval



This study was supported by the Finnish Cultural Foundation, Emil Aaltonen Foundation, grants from the Hospital District of Southwest Finland and Lieto Health Centre, and the scholarship fund of the Ageing, Wellbeing and Technology graduate school.We are indebted to all those persons who attended data collection in the Lieto study, and especially to Jukka Saukkoriipi for technical assistance in biostatistics.


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Copyright information

© Springer Science+Business Media B.V. 2008

Authors and Affiliations

  • Maarit Piirtola
    • 1
    • 2
    Email author
  • Tero Vahlberg
    • 3
  • Minna Löppönen
    • 1
    • 2
  • Ismo Räihä
    • 1
    • 4
    • 5
  • Raimo Isoaho
    • 1
    • 4
    • 6
  • Sirkka-Liisa Kivelä
    • 1
    • 7
    • 8
  1. 1.Department of Family MedicineUniversity of TurkuTurkuFinland
  2. 2.Härkätie Health CentreLietoFinland
  3. 3.Department of BiostatisticsUniversity of TurkuTurkuFinland
  4. 4.Pori Health CentrePoriFinland
  5. 5.Department of Internal MedicineTurku City HospitalTurkuFinland
  6. 6.Nordic School of Public HealthGothenburgSweden
  7. 7.Satakunta Central HospitalPoriFinland
  8. 8.Unit of Family MedicineTurku University HospitalTurkuFinland

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