Excess mortality following hip fracture : the role of underlying health status

• Published in: Osteoporosis international Vol. 18; no. 11; pp. 1463 - 1472
• Main Authors: TOSTESON, A. N. A, GOTTLIEB, D. J, RADLEY, D. C, FISHER, E. S, MELTON, L. J
• Format: Journal Article
• Language: English
• Published: London Springer 01-11-2007; Springer Nature B.V
• Subjects: Activities of Daily Living; Age Distribution; Aged; Aged, 80 and over; Biological and medical sciences; Diseases of the osteoarticular system; Epidemiologic Methods; Female; Fractures; Health Status; Health Status Indicators; Hip Fractures - ethnology; Hip Fractures - mortality; Hip joint; Humans; Injuries of the limb. Injuries of the spine; Male; Medical sciences; Mortality; Osteoporosis; Osteoporosis. Osteomalacia. Paget disease; Risk factors; Sex Distribution; Socioeconomic Factors; Time Factors; Traumas. Diseases due to physical agents; United States - epidemiology; United States; Osteoporosis; Hip fracture; Health status; Prognosis; Attributable risk; Mortality; Diseases of the osteoarticular system; Risk factor; Fracture; Trauma; Epidemiology; Hip
• ISSN: 0937-941X; 1433-2965
• DOI: 10.1007/s00198-007-0429-6

We evaluated the long-term excess mortality associated with hip fracture, using prospectively collected data on pre-fracture health and function from a nationally representative sample of U.S. elders. Although mortality was elevated for the first six months following hip fracture, we found no evidence of long-term excess mortality.
The long-term excess mortality associated with hip fracture remains controversial.
To assess the association between hip fracture and mortality, we used prospectively collected data on pre-fracture health and function from a representative sample of U.S. elders in the Medicare Current Beneficiary Survey (MCBS) to perform survival analyses with time-varying covariates.
Among 25,178 MCBS participants followed for a median duration of 3.8 years, 730 sustained a hip fracture during follow-up. Both early (within 6 months) and subsequent mortality showed significant elevations in models adjusted only for age, sex and race. With additional adjustment for pre-fracture health status, functional impairments, comorbid conditions and socioeconomic status, however, increased mortality was limited to the first six months after fracture (hazard ratio [HR]: 6.28, 95% CI: 4.82, 8.19). No increased mortality was evident during subsequent follow-up (HR: 1.04, 95% CI: 0.88, 1.23). Hip-fracture-attributable population mortality ranged from 0.5% at age 65 among men to 6% at age 85 among women.
Hip fracture was associated with substantially increased mortality, but much of the short-term risk and all of the long-term risk was explained by the greater frailty of those experiencing hip fracture.