Excess mortality following hip fracture: a systematic epidemiological review
ABSTRACT This systematic literature review has shown that patients experiencing hip fracture after low-impact trauma are at considerable excess risk for death compared with nonhip fracture/community control populations. The increased mortality risk may persist for several years thereafter, highlighting the need for interventions to reduce this risk.Patients experiencing hip fracture after low-impact trauma are at considerable risk for subsequent osteoporotic fractures and premature death. We conducted a systematic review of the literature to identify all studies that reported unadjusted and excess mortality rates for hip fracture. Although a lack of consistent study design precluded any formal meta-analysis or pooled analysis of the data, we have shown that hip fracture is associated with excess mortality (over and above mortality rates in nonhip fracture/community control populations) during the first year after fracture ranging from 8.4% to 36%. In the identified studies, individuals experienced an increased relative risk for mortality following hip fracture that was at least double that for the age-matched control population, became less pronounced with advancing age, was higher among men than women regardless of age, was highest in the days and weeks following the index fracture, and remained elevated for months and perhaps even years following the index fracture. These observations show that patients are at increased risk for premature death for many years after a fragility-related hip fracture and highlight the need to identify those patients who are candidates for interventions to reduce their risk.
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ABSTRACT: One-year mortality after hip fracture may exceed 30% with a very large number of reported risk factors. Determinants of mortality beyond 1 year are rarely described. This study employs multiple data linkages to examine mortality rates, risk factor profiles and age-specific excess mortality at intervals from 30 days to 4 years. Retrospective cohort study of linked administrative datasets describing hospital episodes, residential aged care (RAC) admissions and date of death for 2552 Australian veterans and war widows hospitalised for hip fracture in 2008-09. Associations between time to death and patient age, sex, pre-fracture accommodation, fracture type, treatment options, selected comorbidities and complications were tested in Cox proportional hazards models. In a population with mean age of 86.6 years (range 54-100 years), overall death rate was 11% at 30 days, 34% at 1 year, 47% at 2 years and 67% after 4 years. For males hospitalised from RAC 1-year mortality was 72%, contrasting with 19% for females from the community. Risk of death within 1 year was increased by male sex, increasing age, pre-fracture RAC residency, transfer to intensive care and coexistent cancer, cardiac and renal failure, cerebrovascular disease and pressure ulcers. Patients selected for rehabilitation had lower mortality rates. Patterns of determinants for mortality changed over time. Above-expected age-specific mortality was sustained for 4 years except for males 90 years and older. Pre-fracture RAC residence was the strongest determinant factor for mortality. Patients selected for rehabilitation had lower mortality rates. The profiles of explanatory variables for death altered with increasing time from the index fracture event. Copyright © 2015. Published by Elsevier Ltd.Injury 03/2015; 307(6). DOI:10.1016/j.injury.2015.03.006 · 2.46 Impact Factor
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ABSTRACT: Abstract: BackgroundCurrent clinical methods for fracture prediction rely on two-dimensional imaging methods such as dual-energy x-ray absorptiometry and have limited predictive value. Several researchers have tried to integrate three-dimensional imaging techniques with the finite element (FE) method to improve the accuracy of fracture predictions. Before FE models could be used in clinical settings, a thorough validation of their accuracy is required. In this paper, we try to evaluate the current state of accuracy of subject-specific FE models that are used for prediction of the fracture load of proximal femora.MethodsAll the studies that have used FE for prediction of fracture load and have compared the predicted fracture load with experimentally measured fracture loads in vitro are identified through a systematic search of the literature. A quantitative analysis of the results of those studies has been carried out to determine the absolute prediction error, percentage error, and linear correlations between predicted and measured fracture loads.FindingsThe reported coefficients of determination (R2) vary between 0.773 and 0.96 while the percentage error in prediction of fracture load varies between 5 and 46% with most studies reporting percentage errors between 10 and 20%.InterpretationWe conclude that FE models, which are currently used only experimentally, are in general more accurate than clinically used fracture risk assessment techniques. However, the accuracy of FE models depends on the details of their modeling methodologies. Therefore, modeling procedures need to be optimized and standardized before FE could be used in clinical settings.Clinical Biomechanics 04/2014; DOI:10.1016/j.clinbiomech.2013.12.018 · 1.88 Impact Factor
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ABSTRACT: Hip fractures are associated with increased mortality and their incidence in Norway is one of the highest worldwide. The aim of this nationwide study was to examine short and long term mortality after hip fractures, burden of disease (attributable fraction and potential years of life lost), and time trends in mortality compared to the total Norwegian population. Information on incident hip fractures between 1999 and 2008 in all persons 50years and older was collected from Norwegian hospitals. Death and emigration dates of the hip fracture patients were obtained through 31 December 2010. Standardized mortality ratios (SMR) were calculated and Poisson regression analyses were used for the estimation of time trends in SMRs. Among the 81,867 patients with a first hip fracture, the 1-year excess mortality was 4.6-fold higher in men, and 2.8-fold higher in women compared to the general population. Although the highest excess mortality was observed during the first two weeks post fracture, the excess risk persisted for twelve years. Mortality rates post hip fracture was higher in men compared to women in all age groups studied. In both genders aged 50years and older, approximately 5% of the total mortality in the population was related to hip fractures. The largest proportion of the potential life-years lost was in the relatively young-old, i.e. less than 80years. In men, the 1-year absolute mortality rates post hip fracture declined significantly between 1999 and 2008, by contrast, the mortality in women increased significantly relatively to the population mortality.Bone 03/2014; DOI:10.1016/j.bone.2014.02.016 · 4.46 Impact Factor