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Causes of death among 93.637 hip fracture patients– data based on the Danish National Registry of causes of death



Excess mortality among hip fracture patients is well documented. Less is known, however, about the causes of death in this group of patients, although existing literature suggests that bronchopneumonia and cardiovascular diseases constitute the leading causes of death. In this study, we investigated the causes of death in Danish hip fracture patients, who died within 30-days after sustaining a hip fracture, with a focus on differences in causes of death between men and women and between different age groups. Furthermore, the frequency of potentially preventable causes of death such as pneumonia, urinary tract infections and thromboembolic events was examined.


All Danish patients aged 18 or more suffering from a hip fracture in the period 2002–2012 were examined for inclusion into the study. Data were collected from the Danish National Patient registry. The last month of 2012 being December was left out since we were looking at 30-days mortality. Logistic regression analysis was used to test the association between 30-day mortality with each of the causes of death adjusted for age, sex and CCI in multivariable models with results presented as odds ratios (OR) with 95% confidence intervals.


During this period, 93,637 patients sustained a hip fracture. Of these, 9504 patients died within 30-days and were included in the study. For patients dead within 30-days after sustaining a hip fracture, the two leading medical causes of death were cardiovascular disease (21.1%) and pneumonia (10.5%) when looking at both genders. A frequent cause of death especially in the younger age group of women less than 50 years old were infections (other than pneumonia) (18.2%) especially urinary tract infections. Pulmonary embolism accounted for 3.9% of causes of deaths in hip fracture patients.


In this study, cardiovascular disease and pneumonia were overall the leading medical causes of death in patients dead within 30-days after sustaining a hip fracture. Apart from pneumonia, another potentially preventable infection in younger female hip fracture patients was urinary tract infections. Pulmonary embolism, another potentially preventable cause of death might be underreported in Danish death certificates.

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  1. Jantzen C, Madsen CM, Lauritzen JB, Jorgensen HL. Temporal trends in hip fracture incidence, mortality, and morbidity in Denmark from 1999 to 2012. Acta Orthop. 2018;89(2):170–6.

    Article  Google Scholar 

  2. Haentjens P, Lamraski G, Boonen S. Costs and consequences of hip fracture occurrence in old age: an economic perspective. Disabil Rehabil. 2005;27(18–19):1129–41.

    CAS  Article  Google Scholar 

  3. Omsland TK, Emaus N, Tell GS, Magnus JH, Ahmed LA, Holvik K, et al. Mortality following the first hip fracture in Norwegian women and men (1999–2008). A NOREPOS study Bone. 2014;63:81–6.

    PubMed  Google Scholar 

  4. Choi HG, Lee YB, Rhyu SH, Kwon BC, Lee JK. Mortality and cause of death postoperatively in patients with a hip fracture: a national cohort longitudinal follow-up study. Bone Joint J. 2018;100B(4):436–42.

    Article  Google Scholar 

  5. Roche JJ, Wenn RT, Sahota O, Moran CG. Effect of comorbidities and postoperative complications on mortality after hip fracture in elderly people: prospective observational cohort study. BMJ. 2005;331(7529):1374.

    CAS  Article  Google Scholar 

  6. Lunde A, Tell GS, Pedersen AB, Scheike TH, Apalset EM, Ehrenstein V, et al. The role of comorbidity in mortality after hip fracture: a nationwide Norwegian Study of 38,126 women with hip fracture matched to a general-population comparison cohort. Am J Epidemiol. 2019;188(2):398–407.

    Article  Google Scholar 

  7. Sheikh HQ, Hossain FS, Aqil A, Akinbamijo B, Mushtaq V, Kapoor H. A comprehensive analysis of the causes and predictors of 30-day mortality following hip fracture surgery. Clin Orthop Surg. 2017;9(1):10–8.

    Article  Google Scholar 

  8. Groff H, Kheir MM, George J, Azboy I, Higuera CA, Parvizi J. Causes of in-hospital mortality after hip fractures in the elderly. Hip Int. 2020;30(2):204–9.

    Article  Google Scholar 

  9. Berggren M, Stenvall M, Englund U, Olofsson B, Gustafson Y. Co-morbidities, complications and causes of death among people with femoral neck fracture - a three-year follow-up study. BMC Geriatr. 2016;16:120.

    Article  Google Scholar 

  10. Chatterton BD, Moores TS, Ahmad S, Cattell A, Roberts PJ. Cause of death and factors associated with early in-hospital mortality after hip fracture. Bone Joint J. 2015;97B(2):246–51.

    Article  Google Scholar 

  11. Shojania KG, Burton EC. The vanishing nonforensic autopsy. N Engl J Med. 2008;358(9):873–5.

    CAS  Article  Google Scholar 

  12. Panula J, Pihlajamaki H, Mattila VM, Jaatinen P, Vahlberg T, Aarnio P, et al. Mortality and cause of death in hip fracture patients aged 65 or older: a population-based study. BMC Musculoskelet Disord. 2011;12:105.

    Article  Google Scholar 

  13. Frost SA, Nguyen ND, Black DA, Eisman JA, Nguyen TV. Risk factors for in-hospital post-hip fracture mortality. Bone. 2011;49(3):553–8.

    Article  Google Scholar 

  14. Schmidt M, Schmidt SA, Sandegaard JL, Ehrenstein V, Pedersen L, Sorensen HT. The Danish National Patient Registry: a review of content, data quality, and research potential. Clin Epidemiol. 2015;7:449–90.

    Article  Google Scholar 

  15. Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40(5):373–83.

    CAS  Article  Google Scholar 

  16. Artaza-Artabe I, Saez-Lopez P, Sanchez-Hernandez N, Fernandez-Gutierrez N, Malafarina V. The relationship between nutrition and frailty: Effects of protein intake, nutritional supplementation, vitamin D and exercise on muscle metabolism in the elderly A systematic review. Maturitas. 2016;93:89–99.

    CAS  Article  Google Scholar 

  17. Stenqvist C, Madsen CM, Riis T, Jorgensen HL, Duus BR, Lauritzen JB, et al. Orthogeriatric service reduces mortality in patients with hip fracture. Geriatr Orthop Surg Rehabil. 2016;7(2):67–73.

    Article  Google Scholar 

  18. von Friesendorff M, McGuigan FE, Wizert A, Rogmark C, Holmberg AH, Woolf AD, et al. Hip fracture, mortality risk, and cause of death over two decades. Osteoporos Int. 2016;27(10):2945–53.

    Article  Google Scholar 

  19. Khan SK, Rushton SP, Shields DW, Corsar KG, Refaie R, Gray AC, et al. The risk of cardiorespiratory deaths persists beyond 30 days after proximal femoral fracture surgery. Injury. 2015;46(2):358–62.

    Article  Google Scholar 

  20. van der Wall EE. Mortality decrease from cardiovascular disease in Europe: 50 % in 30 years! Neth Heart J. 2013;21(10):425–6.

    Article  Google Scholar 

  21. Seyhan Ak E, Ozbas A. The effect of education of nurses on preventing catheter-associated urinary tract infections in patients who undergo hip fracture surgery. J Clin Nurs. 2018;27(5–6):e1078–88.

    Article  Google Scholar 

  22. Perez JV, Warwick DJ, Case CP, Bannister GC. Death after proximal femoral fracture–an autopsy study. Injury. 1995;26(4):237–40.

    CAS  Article  Google Scholar 

  23. Vestergaard P, Rejnmark L, Mosekilde L. Increased mortality in patients with a hip fracture-effect of pre-morbid conditions and post-fracture complications. Osteoporos Int. 2007;18(12):1583–93.

    CAS  Article  Google Scholar 

  24. Farahmand BY, Michaelsson K, Ahlbom A, Ljunghall S, Baron JA. Swedish Hip Fracture Study G Survival after hip fracture. Osteoporos Int. 2005;16(12):1583–90.

    Article  Google Scholar 

  25. Hamza A. Declining rate of autopsies: implications for anatomic pathology residents. Autops Case Rep. 2017;7(4):1–2.

    Article  Google Scholar 

  26. Lyons PG, Kollef MH. Prevention of hospital-acquired pneumonia. Curr Opin Crit Care. 2018;24(5):370–8.

    Article  Google Scholar 

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Authors and Affiliations



CKR: Conceptualization, Investigation, Data analysis, Drafting and revision of manuscript, Approved the final manuscript, JBL: Conceptualization, Approved the final manuscript, HLJ: Conceptualization, Data analysis, Approved the final manuscript.

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Correspondence to Henrik Løvendahl Jørgensen.

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No conflicts of interest were declared for this study.

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Rohold, C.K., Lauritzen, J.B. & Jørgensen, H.L. Causes of death among 93.637 hip fracture patients– data based on the Danish National Registry of causes of death. Eur J Trauma Emerg Surg 48, 1861–1870 (2022).

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  • Hip fractures
  • Mortality
  • Comorbidities
  • Causes of death