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J Bone Miner Res. 2018 May;33(5):795-802. doi: 10.1002/jbmr.3374. Epub 2018 Mar 23.

Comorbidities Only Account for a Small Proportion of Excess Mortality After Fracture: A Record Linkage Study of Individual Fracture Types.

Author information

1
Osteoporosis and Bone Biology, Garvan Institute of Medical Research, Sydney, Australia.
2
Sydney School of Public Health, University of Sydney, Sydney, Australia.
3
Sydney Medical School, University of Sydney, Sydney, Australia.
4
Institute of Bone and Joint Research, Kolling Institute, Sydney, Australia.
5
Clinical School, Royal North Shore Hospital, St Leonards, Australia.
6
Clinical School, Concord Repatriation General Hospital, Sydney, Australia.
7
Centre for Health Technology, University of Technology Sydney, Sydney, Australia.
8
School of Biomedical Engineering, UNSW Sydney, Sydney, Australia.
9
Clinical School, St Vincent's Hospital Sydney, Sydney, Australia.
10
School of Medicine Sydney, University of Notre Dame, Sydney, Australia.
11
Faculty of Medicine, UNSW Sydney, Sydney, Australia.

Abstract

Nonhip, nonvertebral (NHNV) fractures constitute the majority of osteoporotic fractures, but few studies have examined the association between these fractures, comorbidity, and mortality. Our objective was to examine the relationship between individual nonhip, nonvertebral fractures, comorbidities, and mortality. The prospective population-based cohort of 267,043 subjects (45 and Up Study, Australia) had baseline questionnaires linked to hospital administrative and all-cause mortality data from 2006 to 2013. Associations between fracture and mortality were examined using multivariate, time-dependent Cox models, adjusted for age, prior fracture, body mass index, smoking, and comorbidities (cardiovascular disease, diabetes, stroke, thrombosis, and cancer), and survival function curves. Population attributable fraction was calculated for each level of risk exposure. During 1,490,651 person-years, women and men experienced 7571 and 4571 fractures and 7064 deaths and 11,078 deaths, respectively. In addition to hip and vertebral fractures, pelvis, humerus, clavicle, rib, proximal tibia/fibula, elbow and distal forearm fractures in both sexes, and ankle fractures in men were associated with increased multivariable-adjusted mortality hazard ratios ranging from 1.3 to 3.4. Comorbidity independently added to mortality such that a woman with a humeral fracture and 1 comorbidity had a similarly reduced 5-year survival as that of a woman with a hip fracture and no comorbidities. Population mortality attributable to any fracture without comorbidity was 9.2% in women and 5.3% in men. All proximal nonhip, nonvertebral fractures in women and men were associated with increased mortality risk. Coexistent comorbidities independently further increased mortality. Population attributable risk for mortality for fractures was similar to cardiovascular disease and diabetes, highlighting their importance and potential benefit for early intervention and treatment.

KEYWORDS:

AGING; EPIDEMIOLOGY; PRACTICE/POLICY-RELATED ISSUES

PMID:
29314242
DOI:
10.1002/jbmr.3374
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