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. 2018 Jan 21;8(1):e018836.
doi: 10.1136/bmjopen-2017-018836.

Incidence and mortality of fractures by frailty level over 80 years of age: cohort study using UK electronic health records

Rathi Ravindrarajah  1 , Nisha C Hazra  1 , Judith Charlton  1 , Stephen H D Jackson  2 , Alex Dregan  1   2   3 , Martin C Gulliford  1   2   3
Affiliations

Incidence and mortality of fractures by frailty level over 80 years of age: cohort study using UK electronic health records

Rathi Ravindrarajah et al. BMJ Open. .

Abstract

Objective: This study aimed to estimate the association of frailty with incidence and mortality of fractures at different sites in people aged over 80 years.

Design: Cohort study.

Setting: UK family practices from 2001 to 2014.

Participants: 265 195 registered participants aged 80 years and older.

Measurements: Frailty status classified into 'fit', 'mild', 'moderate' and 'severe' frailty. Fractures, classified into non-fragility and fragility, including fractures of femur, pelvis, shoulder and upper arm, and forearm/wrist. Incidence of fracture, and mortality within 90 days and 1 year, were estimated.

Results: There were 28 643 fractures including: non-fragility fractures, 9101; femur, 12 501; pelvis, 2172; shoulder and upper arm, 4965; and forearm/wrist, 6315. The incidence of each fracture type was higher in women and increased with frailty category (femur, severe frailty compared with 'fit', incidence rate ratio (IRR) 2.4, 95% CI 2.3 to 2.6). Fractures of the femur (95-99 years compared with 80-84 years, IRR 2.7, 95% CI 2.6 to 2.9) and pelvis (IRR 2.9, 95% CI 2.5 to 3.3) were strongly associated with age but non-fragility and forearm fractures were not. Mortality within 90 days was greatest for femur fracture (adjusted HR, compared with forearm fracture 4.3, 95% CI 3.7 to 5.1). Mortality was higher in men and increased with age (HR 5.3, 95% CI 4.3 to 6.5 in those over 100 years compared with 80-84 years) but was less strongly associated with frailty category. Similar associations with fractures were seen at 1-year mortality.

Conclusions: The incidence of fractures at all sites was higher in women and strongly associated with advancing frailty status, while the risk of mortality after a fracture was greater in men and was associated with age rather than frailty category.

Keywords: 80 years and over; femur neck fracture; fractures; frailty; mortality.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Incidence rate ratio (IRR) for fractures by site and gender. Estimates are adjusted for age group and frailty status. LL, lower Level; UL, upper level.
Figure 2
Figure 2
Incidence rate ratio (IRR) for fractures by site and age group. Estimates are adjusted for gender and frailty status. LL, lower Level; UL, upper level.
Figure 3
Figure 3
Incidence rate ratio (IRR) for fractures by site and frailty status. Estimates are adjusted for gender and age group. LL, lower Level; UL, upper level.
See this image and copyright information in PMC

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