A recent analysis found poor survival rates after bone fractures in older adults, with fewer than a third of men and half of women surviving five years afterwards, and with hip fractures posing the highest mortality risk.
Survival most dramatically declined within one month after most types of fracture, with a five-year survival being similar to or worse than some common cancers, said the researchers.
The study looked at a cohort of 98 474 Ontario residents aged 66 and older who suffered fractures to parts of the body associated with osteoporosis between January 2011 and March 2015. The patients were grouped into sets based on the fracture site and matched to patients with a similar demographic profile but no bone breaks during the study period.
The fracture cohort was mostly female (73%), and the median age at fracture was 80. In the year before the fracture, up to 45% of the women and 14% of the men had been treated for osteoporosis.
The Washington Post reports that the analysis, published in JBMR Plus, suggested that those within a year of a hip, vertebral or proximal non-hip, non-vertebral fracture were at the highest risk of death. The survival probability was lower for the oldest patients.
Hip fractures had the highest death risk. One year later, just 67.7% of men and 78.5% of women survived, compared with 92.2% of men with no fractures and 93.1% of women without fractures. Less than a third of men and half of women with fractures survived five years after a bone break.
Survival rates were “marginally better” for those with vertebral fractures, the researchers write.
“Survival most dramatically declined within one month after most types of fracture, with a five-year survival being similar to or worse than some common cancers,” said the paper’s lead author, Laval University department of medicine professor Jacques Brown.
The data suggest that intervening immediately after a fracture is best, the researchers write, though they also called for better prevention of falls and fractures.
Those with severe fractures, men and those over 85, were of special concern, they said, but more data are needed to help clinicians target care.
Clinicians might look to cardiovascular medicine for a model of how to monitor and intervene with at-risk patients, they suggested.
Study details
Postfracture survival in a population-based study of adults aged ≥66 yr: a call to action at hospital discharge
Geneviève Vincent, Jonathan Adachi, Emil Schemitsch, Jean-Eric Tarride, Nathan Ho, Rajvi Wani, Jacques Brown.
Published in JBMR Plus in May 2024.
Abstract
Postfracture survival rates provide prognostic information but are rarely reported along with other mortality outcomes in adults aged ≥50 yr. 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 yr 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 nonfracture individuals based on sex, age, and comorbidities. All-cause 1- and 5-yr 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 yr 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-yr RSRs were observed after hip fractures in males (66–85 yr, 51.9%–63.9%; ≥86 yr, 34.5%), followed by vertebral fractures in males (66–85 yr, 53.2%–69.4%; ≥86 yr, 35.5%), and hip fractures in females (66–85 yr, 69.8%–79.0%; ≥86 yr, 52.8%). Although RSRs did not decrease as markedly after dNHNV fractures in younger patients, relatively low 5-yr RSRs were observed in females (75.9%) and males (69.5%) aged ≥86 yr. 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.
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