A single fracture of any proximal bone increases the risk of premature death, according to an observational study reported at the 2015 annual meeting of the American College of Rheumatology.
“We’ve known that having a hip fracture in your 80s doubles the risk of dying within the next year, but what is a surprise in our data is that many other fractures increase the risk of dying. Fractures of the collarbone, humerus, upper arms, and all proximal bones increased risk of dying at least 2-fold,” said lead author Lyn March, MD, PhD, of the Kolling Institute of Bone and Joint Research at The University of Sydney in Australia.
Risk factors for fracture include osteoporosis, which is quite common but underrecognized, she said. Genetics, rheumatoid arthritis, corticosteroid treatment, sedentary lifestyle, and lack of vitamin D all increase the risk of fracture.
“Fracture is often dismissed as a consequence of aging. But it is a big signal. If you have one fracture, you have to be treated for osteoporosis. When we analyze data sets from around the world, we see that less than 20% of people who have fracture are evaluated. We have effective treatments for osteoporosis, and we are not using them,” Dr March told listeners at a press conference.
The study included 125,174 women and 113,499 men enrolled in the “45 and Up Study” from 2006 to 2008, a prospective, population-based cohort study conducted in New South Wales, Australia. Participants were followed for an average of 6 years to death or fracture. The investigators were able to link data on fracture, medications, and death for those participants.
Mean age at enrollment was 63 years. During follow-up, fracture was reported in 14,827 participants (9145 in women and 5682 in men), and death in 15,621 (10,017 in men and 5604 in women).
In men, there were 15.7 deaths per 1000 person-years during follow-up; for those who experienced an incident fracture, the death rate doubled to 33 deaths per 1000 person-years. In women, there were 7.9 deaths for every 1000 person-years, which doubled to 19 deaths per 1000 person-years in those who had a fracture.
When separate fracture sites and risk of death were analyzed, the risk of death was higher for men compared with women for most types of fracture. For example, hip fracture increased the risk of death 2-fold in women and 3-fold in men; fracture of the femur increased the risk of death 2-fold for women and almost 3-fold for men.
This is the largest study to examine the association of fracture with death, and it is the first to identify increased risk of death after almost all fractures, except those of the fingers and toes, after adjusting for other confounding factors.
The next studies will look at cause of death, cause of osteoporotic fracture, and the effect of treatment on risk of death, Dr March said.
- March L, Chen W, Simpson JM, et al. Premature mortality due to fractures in a population-based prospective cohort study of 238,673 older women and men. Presented at: 2015 American College of Rheumatology Annual Meeting; November 7-11, 2015; San Francisco, CA. Abstract 3173.