Hip fracture is associated with an increase in short-term mortality (death within one year) for women ages 65 to 79 years and healthy women ages 80 years and older, although the risk returns to previous levels after one year for women ages 70 years and older, according to a report published online first by Archives of Internal Medicine, one of the JAMA/Archives journals.
Nearly 300,000 hip fractures occur each year in the United States, causing substantial short- and long-term disability and increased mortality. Previous research to determine the mortality risk associated with hip fracture has not always accounted for differences in health status.
"Such methodological limitations have made it difficult to determine whether the noted increase in mortality after hip fracture is the result of underlying poor health or the hip fracture itself," according to the authors. Additionally, studies that explored the influence of age on mortality after hip fracture have conflicting results. The researchers sought to determine the short-term (one year or less), intermediate-term (between one and five years) and long-term (between five and 10 years) mortality associated with hip fracture, as well as whether healthy women ages 80 years and older would have increased mortality associated with hip fracture when compared with healthy controls of the same age.
Erin S. LeBlanc, M.D., M.P.H., from the Center for Health Research, Kaiser Permanente Northwest, Portland, Ore., and colleagues prospectively studied participants in the Study of Osteoporotic Fractures, a large community-based, multicenter study. Participants were recruited between 1986 and 1988 and followed until December 2005; the mean (average) follow-up was 14.4 years. The researchers selected 1,116 women with hip fracture and matched each with four control participants of the same age who did not have hip fracture (n = 4,464) for a total of 5,580 participants. Through a healthy older subset (n = 960) of participants ages 80 years or older who attended a 10-year follow-up examination and reported good or excellent health, the researchers were able to examine the association with health status. The authors determined incident (new-onset) hip fractures by examining radiology reports, and used death certificates to confirm participant deaths.
For participants with hip fracture, the odds of death were twice as high in the year after the fracture as were controls (16.9 percent vs. 8.4 percent). The odds of short-term mortality increased in participants ages 65 to 70 years (16.3 percent vs. 3.7 percent) and 70 to 79 years (16.5 percent vs. 8.9 percent); an increase was also observed in women ages 80 years or older with good or excellent health (15.1 percent vs. 7.2 percent). After one year following fracture, participants with fracture and controls had similar mortality, except those with fracture ages 65 to 70 years who continued to have an increase in mortality.
The authors noted that, because the risk of hip fracture increases with age, hip fractures may become an even larger public health issue as the population ages. According to the results of the study, an association exists between age, health status (in those ages 80 years and older), and short-term mortality after hip fracture.
"If our findings are replicated, they would suggest that research should focus on hip fracture prevention and interventions in these groups that could decrease mortality during that high-risk period," they write. "Women who are 65 to 70 years of age continue to have an increased risk of mortality for up to five to 10 years; therefore, prevention of hip fractures in these women should be of high priority."
(Archives of Internal Medicine Published online September 26, 2011. doi:10.1001/archinternmed.2011.447. Available pre-embargo to the media at http://www.jamamedia.org.)
Editor's Note: This study was supported by grants from the Public Health Service, the National Institute of Arthritis and Musculoskeletal and Skin Diseases and the National Institute on Aging. In addition, Dr. LeBlanc is supported by a grant from the National Center for Research Resources. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
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Archives of Internal Medicine