TY - JOUR
T1 - Long-term mortality following fractures at different skeletal sites
T2 - A population-based cohort study
AU - Melton, L. J.
AU - Achenbach, S. J.
AU - Atkinson, E. J.
AU - Therneau, T. M.
AU - Amin, S.
N1 - Funding Information:
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.
PY - 2013/5
Y1 - 2013/5
N2 - 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.
AB - 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.
KW - Cohort study
KW - Epidemiology
KW - Fractures
KW - Population-based
KW - Survival
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U2 - 10.1007/s00198-012-2225-1
DO - 10.1007/s00198-012-2225-1
M3 - Article
C2 - 23212281
AN - SCOPUS:84885020707
SN - 0937-941X
VL - 24
SP - 1689
EP - 1696
JO - Osteoporosis International
JF - Osteoporosis International
IS - 5
ER -