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Long-term mortality following fractures at different skeletal sites: a population-based cohort study

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Abstract

Summary

Adjusting for age, sex, and precipitating cause, the relative risk of death was increased following fractures at most skeletal sites.

Introduction

This study aims to determine long-term survival following fractures due to any cause at each skeletal site.

Methods

In a historical cohort study, 2,901 Olmsted County, MN, USA, residents ≥35 years old who experienced any fracture in 1989–1991 were followed passively for up to 22 years for death from any cause. Standardized mortality ratios (SMRs) compared observed to expected deaths.

Results

During 38,818 person-years of follow-up, 1,420 deaths were observed when 1,191 were expected (SMR, 1.2; 95 % CI, 1.1–1.3). The overall SMR was greatest soon after fracture, especially among the men, but remained elevated for over a decade thereafter. Adjusting for age and sex, relative death rates were greater for pathological fractures and less for severe trauma fractures compared to the fractures due to no more than moderate trauma. In the latter group, long-term mortality was increased following fractures at many skeletal sites. After further adjustment for precipitating cause, overall SMRs were elevated not only following fractures at the traditional major osteoporotic sites (i.e., distal forearm, proximal humerus, thoracic/lumbar vertebrae, and proximal femur) combined (SMR, 1.2; 95 % CI, 1.1–1.3) but also following all other fracture types combined (SMR 1.2; 95 % CI, 1.1–1.4), excluding the hand and foot fractures not associated with any increased mortality.

Conclusions

The persistence of increased mortality long after the occurrence of a fracture has generally been attributed to underlying comorbidity, but this needs to be defined in much greater detail if specific opportunities are to be identified for reducing the excess deaths observed.

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Acknowledgments

This work was supported by research grant P01 AG04875 and made possible by the Rochester Epidemiology Project (R01 AG034676) from the National Institute on Aging, US Public Health Service. The authors wish to thank Mrs. Judy Bruen and Mrs. Leona Bellrichard for data collection and Mrs. Mary Roberts for assistance in preparing the manuscript.

Conflict of interest

None.

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Authors and Affiliations

  1. Division of Epidemiology, Department of Health Sciences Research, College of Medicine, Mayo Clinic, 200 First Street Southwest, Rochester, MN, 55905, USA

    L. J. Melton III

  2. Biomedical Statistics and Informatics, Department of Health Sciences Research, College of Medicine, Mayo Clinic, Rochester, MN, USA

    S. J. Achenbach, E. J. Atkinson & T. M. Therneau

  3. Division of Rheumatology, Department of Internal Medicine, College of Medicine, College of Medicine, Mayo Clinic, Rochester, MN, USA

    S. Amin

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  1. L. J. Melton III
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  2. S. J. Achenbach
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  3. E. J. Atkinson
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  4. T. M. Therneau
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  5. S. Amin
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Correspondence to L. J. Melton III.

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Melton, L.J., Achenbach, S.J., Atkinson, E.J. et al. Long-term mortality following fractures at different skeletal sites: a population-based cohort study. Osteoporos Int 24, 1689–1696 (2013). https://doi.org/10.1007/s00198-012-2225-1

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  • DOI: https://doi.org/10.1007/s00198-012-2225-1

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