Hospitalisation from fractures in New Zealand octogenarians: LiLACS NZ

Abstract

Longitudinal data quantifying fracture rates beyond 80 years are lacking. Over 5 years, hospitalised fracture incidences increased by 85% in Māori and 73% in non-Māori octogenarians. However, while fracture-related hospital nights increased by 107% in non-Māori, they remained stable for Māori. Hospitalised fracture risk increases markedly with 5 years of advanced ageing.

Purpose: Fractures become increasingly common in people beyond 80 years, the most serious resulting in hospitalisation. This study examines longitudinal changes in hospitalised fractures in octogenarians.

Methods: Hospital discharge records from a cohort study of Māori aged 80-90 years and non-Māori turning 85 years (LiLACS NZ) were used to determine the incidence of hospitalised fractures for 5 years before and 5 years after enrolment.

Results: Records were available for 378 Māori (aged 82.6 ± 2.8 years; mean ± SD) and 498 non-Māori (84.6 ± 0.5 years). In the 5 years prior to enrolment, 22 (5.8%) Māori and 43 (8.6%) non-Māori were hospitalised at least once for fracture, and 29 (7.7%) Māori and 62 (12.4%) non-Māori sustained hospitalised fractures in the 5 years following enrolment. Hospitalised fracture incidences were 1270/100,000 person-years in Māori and 2048/100,000 person-years in non-Māori before enrolment, increasing to 2345 (P = 0.02) and 3541 (P = 0.002) /100,000 person-years in the subsequent 5 years, respectively. Pelvis/femoral fractures accounted for almost half (47%) of fractures. Fracture-related hospital nights increased 107% in non-Māori (P < 0.0001), but remained stable for Māori, from before to after enrolment. Following enrolment, 21% of hospital nights spent by non-Māori women were fracture-related.

Conclusion: In octogenarians, hospitalised fracture risk increased markedly with 5 years of ageing, almost doubling fracture-related hospitalisation time in non-Māori but having little effect on time spent in hospital for Māori. Projections of fracture burden in advanced age need to consider rapidly changing risk with small increases in age and differences between demographic groups.

Keywords: Bone; Elderly; Frailty; Injury; Osteoporosis.