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Multicenter Study
. 2009 Sep 1;181(5):265-71.
doi: 10.1503/cmaj.081720. Epub 2009 Aug 4.

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

George Ioannidis  1 , Alexandra Papaioannou, Wilma M Hopman, Noori Akhtar-Danesh, Tassos Anastassiades, Laura Pickard, Courtney C Kennedy, Jerilynn C Prior, Wojciech P Olszynski, Kenneth S Davison, David Goltzman, Lehana Thabane, Amiran Gafni, Emmanuel A Papadimitropoulos, Jacques P Brown, Robert G Josse, David A Hanley, Jonathan D Adachi
Affiliations
Multicenter Study

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

George Ioannidis et al. CMAJ. .

Abstract

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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Figures

Figure 1
Figure 1
Adjusted* hazard ratios of death among participants with incident hip fracture and death. Adjustments were made for the variables listed in Table 1. Note: CI = confidence interval.
Figure 2
Figure 2
Adjusted hazard ratios of death among participants with incident vertebral fracture and death. Adjustments were made for the variables listed in Table 1. Note: CI = confidence interval.
See this image and copyright information in PMC

Comment in

References

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