title: Relation between fractures and mortality: results from the Canadian Multicentre Osteoporosis Study.
abstract: BACKGROUND
  Fractures have largely been assessed by their impact on quality of life or health care costs. We conducted this study to evaluate the relation between fractures and mortality.
  
  
  METHODS
  A total of 7753 randomly selected people (2187 men and 5566 women) aged 50 years and older from across Canada participated in a 5-year observational cohort study. Incident fractures were identified on the basis of validated self-report and were classified by type (vertebral, pelvic, forearm or wrist, rib, hip and "other"). We subdivided fracture groups by the year in which the fracture occurred during follow-up; those occurring in the fourth and fifth years were grouped together. We examined the relation between the time of the incident fracture and death.
  
  
  RESULTS
  Compared with participants who had no fracture during follow-up, those who had a vertebral fracture in the second year were at increased risk of death (adjusted hazard ratio [HR] 2.7, 95% confidence interval [CI] 1.1-6.6); also at risk were those who had a hip fracture during the first year (adjusted HR 3.2, 95% CI 1.4-7.4). Among women, the risk of death was increased for those with a vertebral fracture during the first year (adjusted HR 3.7, 95% CI 1.1-12.8) or the second year of follow-up (adjusted HR 3.2, 95% CI 1.2-8.1). The risk of death was also increased among women with hip fracture during the first year of follow-up (adjusted HR 3.0, 95% CI 1.0-8.7).
  
  
  CONCLUSIONS
  Vertebral and hip fractures are associated with an increased risk of death. Interventions that reduce the incidence of these fractures need to be implemented to improve survival.
authors: Department of Medicine, McMaster University, Hamilton, Ont. g.ioannidis@sympatico.ca
authors: George
authors: G
authors: Ioannidis
authors: Alexandra
authors: A
authors: Papaioannou
authors: Wilma M
authors: WM
authors: Hopman
authors: Noori
authors: N
authors: Akhtar-Danesh
authors: Tassos
authors: T
authors: Anastassiades
authors: Laura
authors: L
authors: Pickard
authors: Courtney C
authors: CC
authors: Kennedy
authors: Jerilynn C
authors: JC
authors: Prior
authors: Wojciech P
authors: WP
authors: Olszynski
authors: Kenneth S
authors: KS
authors: Davison
authors: David
authors: D
authors: Goltzman
authors: Lehana
authors: L
authors: Thabane
authors: Amiran
authors: A
authors: Gafni
authors: Emmanuel A
authors: EA
authors: Papadimitropoulos
authors: Jacques P
authors: JP
authors: Brown
authors: Robert G
authors: RG
authors: Josse
authors: David A
authors: DA
authors: Hanley
authors: Jonathan D
authors: JD
authors: Adachi
mesh_terms: D000367:Age Factors; D000368:Aged; D002110:Caffeine / Q000008:administration & dosage / Q000009:adverse effects; D002170:Canada / Q000453:epidemiology; D000697:Central Nervous System Stimulants / Q000008:administration & dosage / Q000009:adverse effects; D015331:Cohort Studies; D015897:Comorbidity; D005260:Female; D006620:Hip Fractures / Q000401:mortality*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009043:Motor Activity; D010024:Osteoporosis / Q000453:epidemiology*; D016016:Proportional Hazards Models; D012737:Sex Factors; D012907:Smoking / Q000401:mortality; D016103:Spinal Fractures / Q000401:mortality*; D016019:Survival Analysis; D013997:Time Factors
chemical_list: D000697:Central Nervous System Stimulants; D002110:Caffeine