CMAJ • September 1, 2009; 181 (5). First published August 4, 2009; doi:10.1503/cmaj.081720
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Research

Relation between fractures and mortality: results from the Canadian Multicentre Osteoporosis Study

George Ioannidis, PhD, Alexandra Papaioannou, MD, Wilma M. Hopman, MSc, Noori Akhtar-Danesh, PhD, Tassos Anastassiades, MD, Laura Pickard, MA, Courtney C. Kennedy, MSc, Jerilynn C. Prior, MD, Wojciech P. Olszynski, MD PhD, Kenneth S. Davison, PhD, David Goltzman, MD, Lehana Thabane, PhD, Amiran Gafni, PhD, Emmanuel A. Papadimitropoulos, PhD, Jacques P. Brown, MD, Robert G. Josse, MD, David A. Hanley, MD and Jonathan D. Adachi, MD

From the Departments of Medicine (Ioannidis, Papaioannou, Pickard, Kennedy, Adachi), Nursing (Akhtar-Danesh) and Clinical Epidemiology and Biostatistics (Thabane, Gafni), McMaster University, Hamilton, Ont.; the Departments of Community Health and Epidemiology (Hopman) and Medicine (Anastassiades), Queen’s University, Kingston, Ont.; the Department of Medicine (Prior), University of British Columbia, Vancouver, BC; the Department of Medicine (Olszynski), University of Saskatchewan, Saskatoon, Sask.; the Department of Medicine (Brown, Davison), Laval University, Sainte-Foy, Que.; the Department of Medicine (Goltzman), McGill University, Montréal, Que.; Outcomes Research (Papadimitropoulos), Eli Lilly and Company, Toronto, Ont.; the Department of Medicine (Josse), University of Toronto, Toronto, Ont., and the Department of Medicine (Hanley), University of Calgary, Calgary, Alta.

Correspondence to: Dr. George Ioannidis, 501–25 Charlton Ave. E., Hamilton ON L8N 1Y2; fax 519 579-8341; g.ioannidis{at}sympatico.ca

Background: Fractures have largely been assessed by their impact on quality of life or health care costs. We conducted this study to evaluate the relation between fractures and mortality.

Methods: A total of 7753 randomly selected people (2187 men and 5566 women) aged 50 years and older from across Canada participated in a 5-year observational cohort study. Incident fractures were identified on the basis of validated self-report and were classified by type (vertebral, pelvic, forearm or wrist, rib, hip and "other"). We subdivided fracture groups by the year in which the fracture occurred during follow-up; those occurring in the fourth and fifth years were grouped together. We examined the relation between the time of the incident fracture and death.

Results: Compared with participants who had no fracture during follow-up, those who had a vertebral fracture in the second year were at increased risk of death (adjusted hazard ratio [HR] 2.7, 95% confidence interval [CI] 1.1–6.6); also at risk were those who had a hip fracture during the first year (adjusted HR 3.2, 95% CI 1.4–7.4). Among women, the risk of death was increased for those with a vertebral fracture during the first year (adjusted HR 3.7, 95% CI 1.1–12.8) or the second year of follow-up (adjusted HR 3.2, 95% CI 1.2–8.1). The risk of death was also increased among women with hip fracture during the first year of follow-up (adjusted HR 3.0, 95% CI 1.0–8.7).

Interpretation: Vertebral and hip fractures are associated with an increased risk of death. Interventions that reduce the incidence of these fractures need to be implemented to improve survival.


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Can. Med. Assoc. J. 2009 181: 237. [Full Text] [PDF]

Dans ce numéro
Can. Med. Assoc. J. 2009 181: E70. [Full Text] [PDF]



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What, I've been duped?
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