Long-term survival and fracture risk after hip fracture: a 22-year follow-up in women

Abstract

Hip fracture is associated with high early mortality. Little is known about long-term survival and subsequent fracture risk. The aim of this study was to evaluate survival and fracture risk after hip fracture in women at different ages. All women suffering a hip fracture during 1984-1985 in Malmö, Sweden, were identified (n = 766) and followed up to 22 yr or death. All new radiographic examinations related to musculoskeletal trauma with or without fracture were registered. Survival (mortality) and fracture was evaluated in 5-yr age bands and in age groups (< 75, 75-84, and > or = 85 yr). Mean age was 79.6 +/- 9.9 yr (range, 31.6-99.4 yr), with 42% between 75 and 85 yr of age. Overall 22-yr survival was 6%: 79% at 1 yr, 48% at 5 yr, and 33% at 10 yr (i.e., population at risk). One-year mortality was 7%, 21%, and 33% for < 75, 75-84, and > or = 85 yr of age, respectively, and 95% of those > or = 85 yr were dead at 10 yr. Prior hip fracture did not affect age-adjusted mortality (OR, 1.05; 95% CI, 0.756-1.20; p = 0.15). A total of 768 fractures were registered at 715 occasions in 342 women (45%; mean, 2.3 fractures/woman; range, 1-11 fractures/woman). Of the fracture occasions, 15% occurred within the first year, 27% within 2 yr, and 73% within 5 yr. The residual lifetime fracture risk was 45%, with a mortality-adjusted increase to 86%. The 10-yr fracture risk was 40%; with a mortality-adjusted increased to 65%. In conclusion, almost one half of all women with a hip fracture suffer a new fracture during their remaining lifetime. Fracture risk is highly dependent on age and survival, emphasizing that preventive strategies need to be tailored to each age group specifically.