Mortality after Sustaining Skeletal Fractures in Relation to Age

Abstract

Age-related mortality across fractures in different anatomical regions are sparsely described, since most studies focus on specific age groups or fracture locations. The aim here was to investigate mortality at 30 days and 1 year post-fracture within four different age groups. All patients ≥ 16 years registered in the Swedish Fracture Register (SFR) 2012-2018 were included (n = 262,598 patients) and divided into four age groups: 16-49, 50-64, 65-79, and ≥80 years of age. Standardized mortality ratios (SMR) at 30 days and 1 year after sustaining a fracture were calculated using age- and gender-specific life tables from Statistics Sweden for each of the 27 fracture locations in the four age groups. Absolute mortality rates for the youngest age group for all locations were below 1% and 2% at 30 days and 1 year, respectively. For the patients in the two oldest age groups (65 and older), mortality rates were as high as 5% at 30 days and up to 25% at 1 year for certain fracture locations. For younger patients a few localizations were associated with high SMRs, whereas for the oldest age group 22 out of 27 fracture locations had an SMR of ≥2 at 30 days. Fractures of the femur (proximal, diaphysis, and distal) and humerus diaphysis fractures were among the fractures associated with the highest mortality rates and SMRs within each age group. Moderately high SMRs were further seen for pelvic, acetabulum, spine, and tibia fractures within all age groups. Regardless of age, any type of femur fractures and humerus diaphysis fractures were associated with increased mortality. In the oldest age groups, about twice as many patients died within 1 year after sustaining a fracture in almost any location, as compared with the expected mortality rates, whereas in the youngest age group only fractures in a few locations were associated with a high SMR.

Keywords: AO/OTA classification; fracture; fracture register; fragility fracture; mortality; osteoporosis.

Figure 1

30-day standardized mortality ratios (SMR) for the different fracture locations in four age groups; (a): 16–49 years; (b): 50–64 years; (c): 65–79 years; and (d): ≥80 years. The dots represent SMR, and the horizontal lines represent the 95% confidence intervals.

Figure 2

One-year standardized mortality ratios (SMR) in the different fracture locations in four age groups; (a): 16–49 years; (b): 50–64 years; (c): 65–79 years; and (d): ≥80 years. The points represent SMR and the horizontal lines represent the 95% confidence intervals.