Impact of osteoporotic fracture type and subsequent fracture on mortality:​ the Tromsø Study

Alarkawi, D.<sup>1</sup>; Bliuc, D.<sup>1</sup>; Tran, T.<sup>1</sup>; Ahmed, L. A.<sup>2</sup>; Emaus, N.<sup>3</sup>; Bjørnerem, A.<sup>4,5</sup>; Jørgensen, L.<sup>3</sup>; Christoffersen, T.<sup>3,6</sup>; Eisman, J. A.<sup>1,7,8,9</sup>; Center, J. R.<sup>1,7,8</sup>

Affiliations

¹Bone Biology Division, Garvan Institute of Medical Research, Sydney, Australia

²Institute of Public Health, United Arab Emirates University, Al Ain, UAE

³Department of Health and Care Sciences, UiT, The Arctic University of Norway, Tromsø, Norway

⁴Department of Clinical Medicine, UiT, The Arctic University of Norway, Tromsø, Norway

⁵Department of Obstetrics and Gynecology, University Hospital of North Norway, Tromsø, Norway

⁶Finnmark Hospital Trust, Hammerfest, Norway

⁷Faculty of Medicine, University of New South Wales, Sydney, Australia

⁸Clinical School, St Vincent’s Hospital, Sydney, Australia

⁹School of Medicine Sydney, University of Notre Dame, Sydney, Australia

Abstract and keywords

Summary: Less is known about the impact of non-hip non-vertebral fractures (NHNV) on early death. This study demonstrated increased risk of dying following hip and NHNV fractures which was further increased by a subsequent fracture. This highlights the importance of early intervention to prevent both initial and subsequent fractures and improve survival.

Introduction: Osteoporotic fractures are a major health concern. Limited evidence exists on their impact on mortality in ageing populations. This study examined the contribution of initial fracture type and subsequent fracture on mortality in a Norwegian population that has one of the highest rates of fractures.

Methods: The Tromsø Study is a prospective population-based cohort in Norway. Women and men aged 50+ years were followed from 1994 to 2010. All incident hip and non-hip non-vertebral (NHNV) fractures were registered. NHNV fractures were classified as either proximal or distal. Information on self-reported co-morbidities, lifestyle factors, general health and education level was collected. Multivariable Cox models were used to quantify mortality risk with incident and subsequent fractures analysed as time-dependent variables.

Results: Of 5214 women and 4620 men, 1549 (30%) and 504 (11%) sustained a fracture, followed by 589 (38%) and 254 (51%) deaths over 10,523 and 2821 person-years, respectively. There were 403 (26%) subsequent fractures in women and 68 (13%) in men. Hip fracture was associated with a two-fold increase in mortality risk (HR 2.05, 95% CI 1.73–2.42 in women and 2.49, 95% CI 2.00–3.11 in men). Proximal NHNV fractures were associated with 49% and 81% increased mortality risk in women and men (HR 1.49, 95% CI 1.21–1.84 and 1.81, 95% CI 1.37–2.41), respectively. Distal NHNV fractures were not associated with mortality. Subsequent fracture was associated with 89% and 77% increased mortality risk in women and men (HR 1.89, 95% CI 1.52–2.35 and 1.77, 95% CI 1.16–2.71), respectively.

Conclusion: Hip, proximal NHNV and subsequent fractures were significantly associated with increased mortality risk in the elderly, highlighting the importance of early intervention.

Keywords: Non-hip non-vertebral fractures; Mortality; Tromsø Study; Subsequent fracture

Links

DOI: 10.1007/s00198-019-05174-5

PubMed: 31654084

WoS: 000492560300001

History

Received: 2019-04-04

Accepted: 2019-09-18

Online: 2019-10-26

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Cited By (2)

Year	Entry
2022	Iconaru L, Charles A, Baleanu F, Surquin M, Benoit F, Mugisha A, Moreau M, Paesmans M, Karmali R, Rubinstein M, Rozenberg S, Body J-J, Bergmann P. Prediction of an imminent fracture after an index fracture: models derived from the Frisbee cohort. J Bone Miner Res. January 2022;37(1):59-67.
2023	Alarkawi D, Tran T, Chen W, March LM, Blyth FM, Blank RD, Bliuc D, Center JR. Denosumab and mortality in a real-world setting: a comparative study. J Bone Miner Res. December 2023;38(12):1757-1770.