Relation between fractures and mortality: results from the Canadian Multicentre Osteoporosis Study

Ioannidis, George; Papaioannou, Alexandra; Hopman, Wilma M.; Akhtar-Danesh, Noori; Anastassiades, Tassos; Pickard, Laura; Kennedy, Courtney C.; Prior, Jerilynn C.; Olszynski, Wojciech P.; Davison, Kenneth S.; Goltzman, David; Thabane, Lehana; Gafni, Amiran; Papadimitropoulos, Emmanuel A.; Brown, Jacques P.; Josse, Robert G.; Hanley, David A.; Adachi, Jonathan D.
September 2009
CMAJ: Canadian Medical Association Journal;9/1/2009, Vol. 181 Issue 5, p265
Academic Journal
Background: Fractures have largely been assessed by their impact on quality of life or health care costs. We conducted this study to evaluate the relation between fractures and mortality. Methods: A total of 7753 randomly selected people (2187 men and 5566 women) aged 50 years and older from across Canada participated in a 5-year observational cohort study. Incident fractures were identified on the basis of validated self-report and were classified by type (vertebral, pelvic, forearm or wrist, rib, hip and "other"). We subdivided fracture groups by the year in which the fracture occurred during follow-up; those occurring in the fourth and fifth years were grouped together. We examined the relation between the time of the incident fracture and death. Results: Compared with participants who had no fracture during follow-up, those who had a vertebral fracture in the second year were at increased risk of death (adjusted hazard ratio [HR] 2.7, 95% confidence interval [CI] 1.1-6.6); also at risk were those who had a hip fracture during the first year (adjusted HR 3.2, 95% CI 1.4-7.4). Among women, the risk of death was increased for those with a vertebral fracture during the first year (adjusted HR 3.7, 95% CI 1.1-12.8) or the second year of follow-up (adjusted HR 3.2, 95% CI 1.2-8.1). The risk of death was also increased among women with hip fracture during the first year of follow-up (adjusted HR 3.0, 95% CI 1.0-8.7). Interpretation: Vertebral and hip fractures are associated with an increased risk of death. Interventions that reduce the incidence of these fractures need to be implemented to improve survival.


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