Long-term survival and fracture risk after hip fracture: a 22-year follow-up in women.
Hip fracture is associated with high early mortality. Little is known about long-term survival and subsequent fracture risk. The aim of this study was to evaluate survival and fracture risk after hip fracture in women at different ages. All women suffering a hip fracture during 1984-1985 in Malmö, Sweden, were identified (n = 766) and followed up to 22 yr or death. All new radiographic examinations related to musculoskeletal trauma with or without fracture were registered. Survival (mortality) and fracture was evaluated in 5-yr age bands and in age groups (< 75, 75-84, and > or = 85 yr). Mean age was 79.6 +/- 9.9 yr (range, 31.6-99.4 yr), with 42% between 75 and 85 yr of age. Overall 22-yr survival was 6%: 79% at 1 yr, 48% at 5 yr, and 33% at 10 yr (i.e., population at risk). One-year mortality was 7%, 21%, and 33% for < 75, 75-84, and > or = 85 yr of age, respectively, and 95% of those > or = 85 yr were dead at 10 yr. Prior hip fracture did not affect age-adjusted mortality (OR, 1.05; 95% CI, 0.756-1.20; p = 0.15). A total of 768 fractures were registered at 715 occasions in 342 women (45%; mean, 2.3 fractures/woman; range, 1-11 fractures/woman). Of the fracture occasions, 15% occurred within the first year, 27% within 2 yr, and 73% within 5 yr. The residual lifetime fracture risk was 45%, with a mortality-adjusted increase to 86%. The 10-yr fracture risk was 40%; with a mortality-adjusted increased to 65%. In conclusion, almost one half of all women with a hip fracture suffer a new fracture during their remaining lifetime. Fracture risk is highly dependent on age and survival, emphasizing that preventive strategies need to be tailored to each age group specifically.
von Friesendorff
My
M
Department of Orthopedics, Hässleholm-Kristianstad Hospital, Kristianstad, Sweden. My.vonFriesendorff@skane.se
Besjakov
Jack
J
Akesson
Kristina
K
D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006620:Hip Fractures / Q000150:complications / Q000000981:diagnostic imaging / Q000401:mortality*; D006801:Humans; D053208:Kaplan-Meier Estimate; D011859:Radiography; D012307:Risk Factors; D015996:Survival Rate; D013548:Sweden / Q000453:epidemiology; D013997:Time Factors; D014947:Wounds and Injuries / Q000150:complications