Postfracture survival in a population-based study of adults aged ≥66 yr: a call to action at hospital discharge

Abstract

Post-fracture survival rates provide prognostic information but are rarely reported along with other mortality outcomes in adults aged ≥50 years. The timing of survival change following a fracture also needs to be further elucidated. This population-based, matched-cohort, retrospective database study examined 98 474 patients (73% women) aged ≥66 years with an index fracture occurring at an osteoporotic site (hip, clinical vertebral, proximal non-hip non-vertebral [pNHNV], and distal non-hip non-vertebral [dNHNV]) from 2011 to 2015, who were matched (1:1) to non-fracture individuals based on sex, age, and comorbidities. All-cause 1- and 5-year overall survival and relative survival ratios (RSRs) were assessed and time trends in survival changes were characterized starting immediately after a fracture. In both sexes, overall survival was markedly decreased over 6 years of follow-up after hip, vertebral, and pNHNV fractures, and as expected, worse survival rates were observed in older patients and males. The lowest 5-year RSRs were observed after hip fractures in males (66–85 years, 51.9%–63.9%; ≥86 years, 34.5%), followed by vertebral fractures in males (66–85 years, 53.2%–69.4%; ≥86 years, 35.5%), and hip fractures in females (66–85 years, 69.8%–79.0%; ≥86 years, 52.8%). Although RSRs did not decrease as markedly after dNHNV fractures in younger patients, relatively low 5-year RSRs were observed in females (75.9%) and males (69.5%) aged ≥86 years. The greatest reduction in survival occurred within the initial month after hip, vertebral, and pNHNV fractures, indicating a high relative impact of short-term factors, with survival-reduction effects persisting over time. Therefore, the most critical period for implementing interventions aimed at improving post-fracture prognosis appears to be immediately after a fracture; however, considering the immediate need for introducing such interventions, primary fracture prevention is also crucial to prevent the occurrence of the initial fracture in high-risk patients.

It is not “just a fracture”

“…In their recent population–based study of nearly 100 000 patients from Ontario, Canada, who had suffered a fracture, Vincent et al. 1 characterized postfracture survival rates. They found that overall survival was decreased following fracture, particularly following fractures of the hip or vertebrae, with the increased mortality risk starting immediately after fracture occurrence.…”