Mortality Risk Associated With Low-Trauma Osteoporotic Fracture and Subsequent Fracture in Men and Women

Abstract

Context There are few data on long-term mortality following osteoporotic fracture and fewer following subsequent fracture.Objectives To examine long-term mortality risk in women and men following all osteoporotic fractures and to assess the association of subsequent fracture with that risk. Design, Setting, and ParticipantsProspective cohort from the Dubbo Osteoporosis Epidemiology Study of community-dwelling women and men aged 60 years and older from Dubbo, Australia, who sustained a fracture between April 1989 and May 2007.Main Outcome Measures Age-and sex-specific standardized mortality ratios (SMRs) compared with the overall Dubbo population for hip, vertebral, major, and minor fractures. ResultsIn women, there were 952 low-trauma fractures followed by 461 deaths, and in men, 343 fractures were followed by 197 deaths. Age-adjusted SMRs were increased following hip fractures (SMRs, 2.43 [95% confidence interval [CI], 2.02-2.93] and 3.51 [95% CI, 2.65-4.66]), vertebral fractures (SMRs, 1.82 [95% CI, 1.52-2.17] and 2.12 [95% CI, 1.66-2.72]), major fractures (SMRs, 1.65 [95% CI, 1.31-2.08] and 1.70 [95% CI, 1.23-2.36]), and minor fractures (SMRs, 1.42 [95% CI, 1.19-1.70] and 1.33 [95% CI, 0.99-1.80]) for both women and men, respectively.Mortality was increased for all ages for all fractures except minor fractures for which increased mortality was only apparent for those older than 75 years. Increased mortality risk persisted for 5 years for all fractures and up to 10 years for hip fractures. Increases in absolute mortality that were above expected, for 5 years after fracture, ranged from 1.3 to 13.2 per 100 person-years in women and from 2.7 to 22.3 per 100 person-years in men, depending on fracture type. Subsequent fracture was associated with an increased mortality hazard ratio of 1.91 (95% CI, 1.54-2.37) in women and 2.99 (95% CI, 2.11-4.24) in men. Mortality risk following a subsequent fracture then declined but beyond 5 years still remained higher than in the general population (SMR, 1.41 [95% CI, 1.01-1.97] and SMR, 1.78 [95% CI, 0.96-3.31] for women and men, respectively). Predictors of mortality after any fragility fracture for both men and women included age, quadriceps weakness, and subsequent fracture but not comorbidities. Low bone mineral density, having smoked, and sway were also predictors for women and less physical activity for men. ConclusionsIn a sample of older women and men, all low-trauma fractures were associated with increased mortality risk for 5 to 10 years. Subsequent fracture was associated with increased mortality risk for an additional 5 years.

Inhibition of sclerostin by monoclonal antibody enhances bone healing and improves bone density and strength of nonfractured bones

“…(31) Patients experiencing these secondary osteoporotic fractures have a greater incidence of death. (32) Therefore, an anabolic therapy that increases bone strength throughout the skeleton while improving fracture healing should reduce the risk of a secondary osteoporotic fracture. In male rats, Scl-Ab increased serum markers of bone formation, as well as bone mass and strength of the femoral midshaft, similar to a previous report in aged ovariectomized (OVX) rats.…”

Height loss starting in middle age predicts increased mortality in the elderly

“…(45,46) Risk factors such as age, diabetes, hypertension, inflammation, dislipidemia, homocystienemia, and estrogen deficiency are prevalent in both disorders. (44,47) Osteoporotic fracture and mortality Bliuc et al (48) reported that excess mortality was highest immediately after almost all fragility fracture events and then declined. The researchers observed that 30% of all post-hipfracture deaths occurred in the first six months and 21% in the next 18 months.…”

“…Furthermore, participants were atomic bomb survivors and thus not representative of the general Japanese population, although we adjusted for radiation, and there are no indications from earlier studies of this cohort that radiation affected BMD and fracture frequency. (38,48,50) …”

Genetic profiling and individualized prognosis of fracture

“…(1) Individuals with a preexisting fracture are at increased risk of subsequent fracture (2) and death. (3) Pharmacologic treatment of individuals with a preexisting fracture can reduce further fracture (4) and mortality risk. (5) Therefore, a major priority in osteoporosis research at present is to develop prognostic models for identifying individuals who have high risk of fracture.…”