The Association of Cold Ambient Temperature With Fracture Risk and Mortality: National Data From Norway—A Norwegian Epidemiologic Osteoporosis Studies (NOREPOS) Study

Abstract

Norway is an elongated country with large variations in climate and duration of winter season. It is also a high‐risk country for osteoporotic fractures, in particular hip fractures, which cause high mortality. Although most hip fractures occur indoors, there is a higher incidence of both forearm and hip fractures during wintertime, compared with summertime. In a nationwide longitudinal cohort study, we investigated whether cold ambient (outdoor) temperatures could be an underlying cause of this high incidence and mortality. Hospitalized/outpatient forearm fractures (International Classification of Diseases and Related Health Problems, 10th Revision [ICD‐10] code S52) and hospitalized hip fractures (ICD‐10 codes S72.0–S72.2) from 2008 to 2018 were retrieved from the Norwegian Patient Registry. Average monthly ambient temperatures (degrees Celsius, °C) from the years 2008 to 2018 were provided by the Norwegian Meteorological Institute and linked to the residential area of each inhabitant. Poisson models were fitted to estimate the association (incidence rate ratios [IRRs], 95% confidence intervals [CIs]) between temperature and monthly incidence of total number of forearm and hip fractures. Flexible parametric survival models (hazard ratios [HR], 95% CI) were used to estimate the association between temperature and post–hip fracture mortality, taking the population mortality into account. Monthly temperature ranged from −20.2°C to 22.0°C, with a median of −2.0°C in winter and 14.4°C in summer. At low temperatures (<0°C) compared to ≥0°C, there was a 53% higher risk of forearm fracture (95% CI, 51%–55%) and 21% higher risk of hip fracture (95% CI, 19%–22%), adjusting for age, gender, calendar year, urbanization, residential region, elevation, and coastal proximity. When taking the population mortality into account, the post–hip fracture mortality in both men (HR 1.08; 95% CI, 1.02–1.13) and women (HR 1.09; 95% CI, 1.04–1.14) was still higher at cold temperatures. There was a higher risk of forearm and hip fractures, and an excess post–hip fracture mortality at cold ambient temperatures. © 2022 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).

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“…Previous studies have shown a link between fractures and temperature, with Cecilie et al suggesting that cold ambient temperatures can increase the incidence of forearm and hip fractures, as well as post-hip fracture mortality. [ 27 ] Additionally, Kinga et al found that changes in fracture incidence were related to season (warmer vs colder) and the increase in mean temperature during the observation period. [ 28 ] This could be due to the need for thicker clothing in cold weather, resulting in repeated movements due to the inconvenience of exposing the affected limb during the emergency examination.…”

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“… 21 , 22 Norway is a high-incidence country when it comes to osteoporotic fractures, especially hip fractures, with among the highest rates in the world. 23 Hip fractures are associated with substantial functional decline and long-term institutionalization, 24 as well as increased mortality and morbidity, 25 and functional recovery depends on both surgical variables 26 and level of frailty. 27 Other fracture types such as osteoporotic vertebral fractures and upper extremity fractures, are also severe and linked to higher mortality.…”