ArticlesMortality after all major types of osteoporotic fracture in men and women: an observational study
Introduction
Although osteoporosis and related fractures are wellrecognised public-health concerns, their impact on mortality remains unclear. Increased mortality after hip fracture is generally accepted, but there are few data on the outcomes of other fracture types. Excess mortality varies after hip fracture, with 12-month rates ranging from 12% to 35%.1 The variation in these mortality estimates may relate to differences in demography, age of people studied, study size, and completeness and length of follow-up. Most excess mortality occurs within the first 3–12 months after fracture,2, 3, 4, 5 and increases with age.5, 6, 7, 8, 9, 10, 11
In women, low bone-mineral density has been associated with increased mortality independent of fracture.12, 13 At least some of the fracture-mortality association may, therefore, reflect the underlying health of the individual. Although comorbid health status has been associated with mortality after hip fracture in most studies,3, 5, 6, 7, 14, 15, 16, 17, 18, 19 this finding has not been universal.20
If osteoporosis is independently associated with mortality, increased mortality could be associated with other types of osteoporotic fractures. In one populationbased study, women with vertebral fractures had increased 5-year mortality.21 These were clinically diagnosed vertebral fractures that may represent only a third of all vertebral deformities. By contrast, the survival of women with forearm fractures,21, 22, 23 foot, or ankle fractures23 has been reported to be no different from that of the general community.
In men, several studies have investigated mortality after hip fracture but not other fracture types. Direct comparisons of results when possible have shown that survival seems to be worse in men than in women.3, 4, 5, 6, 7, 9, 10, 17, 24
We investigated mortality associated with all osteoporotic fractures in an elderly community cohort.
Section snippets
Patients
Dubbo is a semi-urban city 400 km northwest of Sydney, Australia. The population is about 32 000, of which 98·6% of people are white. The community is stable with its own centralised health services, and is representative of the Australian population.25
The Dubbo Osteoporosis Epidemiology Study is a longitudinal epidemiological study assessing risk factors for osteoporosis and fractures, which started in July, 1989. As part of that study, all radiography reports from the whole Dubbo population
Results
Between 1989 and 1994, there were 356 low-trauma fractures in women and 137 in men during 12 056 personyears and 9483 person-years of observation, respectively. The overall fracture incidence (per 1000 person-years) was 29·5 for women and 14·4 for men. In the two sexes, fracture rates increased with age, with an exponential increase for proximal femur and vertebral fractures. The increase for other major fractures was gradual, whereas incidence of minor fractures was generally constant. Among
Discussion
In an elderly population, we found that fracture patients had a higher mortality than did the general population, especially those with hip fractures. Men in all major fracture groups had consistently higher standardised mortality ratios (2·2–3·2) than women (1·7–2·2).
The attributable risk of mortality was higher in the 60–69-year age-group than in the 80-years-or-older agegroup because of larger numbers. It was, therefore, not surprising to find a large number of excess deaths and strikingly
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