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Time since prior fracture affects mortality at the time of clinical assessment: a registry-based cohort study

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Abstract

Summary

Fractures are associated with increased long-term mortality in patients surviving to undergo baseline DXA. Notably, excess mortality risk does not decline with increasing time since prior hip or humerus fractures, even after accounting for comorbid medical conditions and other risk factors.

Introduction

Mortality risk increases following most types of fracture. In routine clinical practice, patients with prior fractures seen for dual-energy X-ray absorptiometry scan (DXA) are “survivors;” whether they remain at increased mortality risk is unknown. We tested the association between prior fracture and all-cause mortality, stratified by time since fracture, in patients undergoing baseline DXA.

Methods

We conducted a DXA registry-based cohort study and linked to population-based health services data for the Province of Manitoba, Canada. We identified women and men ≥ 40 years with minimum 10 years of prior healthcare coverage undergoing baseline DXA and ascertained prior fracture codes since 1984 and mortality to 2017. Time since prior fracture was calculated between the clinical encounter for the fracture and baseline DXA (index date). Cox proportional hazards models estimated hazard ratios for all-cause mortality in those with compared to those without prior fracture adjusted for (1) age and sex, and (2) age, sex, comorbidities, and other covariates.

Results

The study cohort consisted of 74,474 individuals (mean age 64.6 years, 89.7% female). During mean follow-up 9.2 years, we ascertained 14,923 (20.0%) deaths. Except for forearm fractures, all fracture sites were associated with increased mortality risk compared to those without prior fracture, even after multivariable adjustment. Excess mortality risk tended to decline slightly with time since fracture and was no longer significant > 10 years after vertebral fracture. However, excess mortality persisted > 10 years following hip or humerus fracture.

Conclusions

Prior fractures are associated with increased long-term mortality in patients surviving to undergo baseline DXA. Excess mortality risk does not decline with time since prior hip or humerus fractures, after accounting for potential confounders. Fracture prevention may have important long-term benefits preserving life expectancy.

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Acknowledgements

The authors acknowledge the Manitoba Centre for Health Policy for use of data contained in the Population Health Research Data Repository (HIPC 2016/2017-29). The results and conclusions are those of the authors and no official endorsement by the Manitoba Centre for Health Policy, Manitoba Health, Seniors and Active Living, or other data providers is intended or should be inferred. This work has been reviewed and approved by the members of the Manitoba Bone Density Program Committee.

Funding

SNM is chercheur-boursier des Fonds de Recherche du Québec en Santé. LML is supported by a Tier I Canada Research Chair. No funding was received for this research.

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Authors and Affiliations

  1. University of Alberta, Edmonton, Canada

    C. Ye

  2. Park Nicollet Clinic & HealthPartners Institute, Minneapolis, MN, USA

    J. T. Schousboe

  3. University of Minnesota, Minneapolis, MN, USA

    J. T. Schousboe

  4. McGill University, Montreal, Canada

    S. N. Morin

  5. University of Manitoba, Winnipeg, Canada

    L. M. Lix

  6. Department of Medicine (C5121), University of Manitoba, 409 Tache Avenue, Winnipeg, R2H 2A6, Canada

    W. D. Leslie

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  1. C. Ye
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  2. J. T. Schousboe
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  3. S. N. Morin
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  4. L. M. Lix
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  5. W. D. Leslie
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Correspondence to W. D. Leslie.

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Ye, C., Schousboe, J.T., Morin, S.N. et al. Time since prior fracture affects mortality at the time of clinical assessment: a registry-based cohort study. Osteoporos Int 33, 1257–1264 (2022). https://doi.org/10.1007/s00198-021-06236-3

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  • DOI: https://doi.org/10.1007/s00198-021-06236-3

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