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Hip and back fractures increase mortality rates in older adults

McMaster University

If you are 50 or older and you break your hip, you have a one in four chance of dying within five years. Break your back, and you have a one in six chance of dying that soon, says a McMaster University study.

The research, to be published August 4 in the online edition of the Canadian Medical Association Journal (CMAJ), has found that approximately 25 per cent of men and women who develop hip fractures and 16 per cent of people who develop spine factures will die over a five-year period.

The national study was led by George Ioannidis, a health research methodologist in the Michael G. DeGroote School of Medicine, in collaboration with scientists from the schools of medicine and nursing at McMaster, as well as several universities across Canada.

Using data from the Canadian Multicentre Osteoporosis Study, the researchers examined the relationship between new fractures and mortality over a 5-year period in more than 7,750 Canadians aged 50 years and older. The study, looking at various types of fractures reported by participants, differed from previous research in that the study group was representative of the general population.

"Hip fractures may have long-lasting effects that result in eventual death by signalling or actually inducing a progressive decline in health," said Ioannidis. "Our results also showed that vertebral fracture was an independent predictor of death."

In addition, the researchers discovered that all types of bone breaks were more common among women than men, with the exception of rib fractures. They also determined that fractures were associated with other negative consequences such as increased pain, immobility and reduced health-related quality of life.

"People should be aware that fractures are a serious problem in osteoporosis," Ioannidis said. "They do not just reduce health-related quality of life, they actually cause death. So hip and spinal fractures need be taken very seriously, and prevention should be paramount in treating patients with osteoporosis."

The study found factors such as smoking, physical activity and the presence of other diseases increased the risk of death, but so did lower educational levels.

The authors concluded that interventions must be introduced to reduce the likelihood of fractures. These could include osteoporosis medications, fall prevention strategies, hip protectors and enhanced rehabilitation after fracture to improve mobility and strength.

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The study was funded by the Canadian Institutes of Health Research.

Osteoporosis Canada reports that there are approximately 27,000 hip fractures per year in Canada. Data on spinal fractures is limited, but is estimated that more than 65 per cent of vertebral fractures go undetected. The annual cost of treating osteoporotic fractures is over $1.3 billion.

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