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Excess mortality following hip fracture: the role of underlying health status

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Abstract

Summary

We evaluated the long-term excess mortality associated with hip fracture, using prospectively collected data on pre-fracture health and function from a nationally representative sample of U.S. elders. Although mortality was elevated for the first six months following hip fracture, we found no evidence of long-term excess mortality.

Introduction

The long-term excess mortality associated with hip fracture remains controversial.

Methods

To assess the association between hip fracture and mortality, we used prospectively collected data on pre-fracture health and function from a representative sample of U.S. elders in the Medicare Current Beneficiary Survey (MCBS) to perform survival analyses with time-varying covariates.

Results

Among 25,178 MCBS participants followed for a median duration of 3.8 years, 730 sustained a hip fracture during follow-up. Both early (within 6 months) and subsequent mortality showed significant elevations in models adjusted only for age, sex and race. With additional adjustment for pre-fracture health status, functional impairments, comorbid conditions and socioeconomic status, however, increased mortality was limited to the first six months after fracture (hazard ratio [HR]: 6.28, 95% CI: 4.82, 8.19). No increased mortality was evident during subsequent follow-up (HR: 1.04, 95% CI: 0.88, 1.23). Hip-fracture-attributable population mortality ranged from 0.5% at age 65 among men to 6% at age 85 among women.

Conclusions

Hip fracture was associated with substantially increased mortality, but much of the short-term risk and all of the long-term risk was explained by the greater frailty of those experiencing hip fracture.

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Acknowledgments

This study was supported by NIH grant AG12262, U.S. Public Health Service. The authors thank Ms. Loretta Pearson for editorial assistance and a comprehensive literature review and Ms. Margaret Grove for assistance with figure preparation.

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Authors and Affiliations

  1. Multidisciplinary Clinical Research Center in Musculoskeletal Diseases, Dartmouth Medical School, Lebanon, NH, USA

    A. N. A. Tosteson, D. C. Radley & E. S. Fisher

  2. Center for the Evaluative Clinical Sciences, Departments of Medicine and of Community and Family Medicine, Dartmouth Medical School, Hanover, NH, USA

    A. N. A. Tosteson, D. J. Gottlieb, D. C. Radley & E. S. Fisher

  3. Department of Health Sciences Research, Mayo Clinic College of Medicine, Rochester, MN, USA

    L. J. Melton III

  4. Clinical Research HB7505, Dartmouth Medical School, One Medical Center Drive, Lebanon, NH, 03756, USA

    A. N. A. Tosteson

Authors
  1. A. N. A. Tosteson
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  2. D. J. Gottlieb
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  3. D. C. Radley
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  4. E. S. Fisher
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  5. L. J. Melton III
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Corresponding author

Correspondence to A. N. A. Tosteson.

Appendix

Appendix

Table 3 Hazard ratios (95% confidence intervals) estimated for each model
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Tosteson, A.N.A., Gottlieb, D.J., Radley, D.C. et al. Excess mortality following hip fracture: the role of underlying health status. Osteoporos Int 18, 1463–1472 (2007). https://doi.org/10.1007/s00198-007-0429-6

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  • DOI: https://doi.org/10.1007/s00198-007-0429-6

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