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

¹ Departments of Medicine, McMaster University, Hamilton, Ont.
² Department of Community Health and Epidemiology, Queen's University, Kingston, Ont.
³ Departments of Nursing, McMaster University, Hamilton, Ont.
⁴ Department of Medicine, Queen's University, Kingston, Ont.
⁵ Department of Medicine, University of British Columbia, Vancouver, BC
⁶ Department of Medicine, University of Saskatchewan, Saskatoon, Sask.
⁷ Department of Medicine, Laval University, Sainte-Foy, Que.
⁸ Department of Medicine, McGill University, Montréal, Que.
⁹ Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ont.
¹⁰ Outcomes Research, Eli Lilly and Company, Toronto, Ont.
¹¹ Department of Medicine, University of Toronto, Toronto, Ont.
¹² Department of Medicine, University of Calgary, Calgary, Alta.
¹³ Department of Medicine, McMaster University, Hamilton, Ont.

	Abstract

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 (adjust ed 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.