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. 2020 Jan;31(1):119-130.
doi: 10.1007/s00198-019-05174-5. Epub 2019 Oct 26.

Impact of osteoporotic fracture type and subsequent fracture on mortality: the Tromsø Study

D Alarkawi  1 , D Bliuc  2 , T Tran  2 , L A Ahmed  3 , N Emaus  4 , A Bjørnerem  5   6 , L Jørgensen  4 , T Christoffersen  4   7 , J A Eisman  2   8   9   10 , J R Center  2   8   9
Affiliations

Impact of osteoporotic fracture type and subsequent fracture on mortality: the Tromsø Study

D Alarkawi et al. Osteoporos Int. 2020 Jan.

Abstract

Less is known about the impact of non-hip non-vertebral fractures (NHNV) on early death. This study demonstrated increased risk of dying following hip and NHNV fractures which was further increased by a subsequent fracture. This highlights the importance of early intervention to prevent both initial and subsequent fractures and improve survival.

Introduction: Osteoporotic fractures are a major health concern. Limited evidence exists on their impact on mortality in ageing populations. This study examined the contribution of initial fracture type and subsequent fracture on mortality in a Norwegian population that has one of the highest rates of fractures.

Methods: The Tromsø Study is a prospective population-based cohort in Norway. Women and men aged 50+ years were followed from 1994 to 2010. All incident hip and non-hip non-vertebral (NHNV) fractures were registered. NHNV fractures were classified as either proximal or distal. Information on self-reported co-morbidities, lifestyle factors, general health and education level was collected. Multivariable Cox models were used to quantify mortality risk with incident and subsequent fractures analysed as time-dependent variables.

Results: Of 5214 women and 4620 men, 1549 (30%) and 504 (11%) sustained a fracture, followed by 589 (38%) and 254 (51%) deaths over 10,523 and 2821 person-years, respectively. There were 403 (26%) subsequent fractures in women and 68 (13%) in men. Hip fracture was associated with a two-fold increase in mortality risk (HR 2.05, 95% CI 1.73-2.42 in women and 2.49, 95% CI 2.00-3.11 in men). Proximal NHNV fractures were associated with 49% and 81% increased mortality risk in women and men (HR 1.49, 95% CI 1.21-1.84 and 1.81, 95% CI 1.37-2.41), respectively. Distal NHNV fractures were not associated with mortality. Subsequent fracture was associated with 89% and 77% increased mortality risk in women and men (HR 1.89, 95% CI 1.52-2.35 and 1.77, 95% CI 1.16-2.71), respectively.

Conclusion: Hip, proximal NHNV and subsequent fractures were significantly associated with increased mortality risk in the elderly, highlighting the importance of early intervention.

Keywords: Mortality; Non-hip non-vertebral fractures; Subsequent fracture; Tromsø Study.

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