Impact of Osteoporotic Fracture Type and Subsequent Fracture on Mortality: The Tromsø Study

• Published in: Osteoporosis International
• Main Authors: Alarkawi, Dunia, Bluic, Dana, Tran, T, Ahmed, Luai A, Emaus, Nina, Bjørnerem, Åshild, Jørgensen, Lone, Cristoffersen, T., Eisman, JA, Center, JR
• Format: Article in Journal/Newspaper
• Language: English
• Published: Springer 2019
• Subjects: VDP::Medical disciplines: 700; VDP::Medisinske Fag: 700; Norway; Tromsø
• Online Access: https://hdl.handle.net/10037/17897; https://doi.org/10.1007/s00198-019-05174-5

Summary - 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.