Relation between fractures and mortality: results from the Canadian Multicentre Osteoporosis Study.
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.
Ioannidis
George
G
Department of Medicine, McMaster University, Hamilton, Ont. g.ioannidis@sympatico.ca
Papaioannou
Alexandra
A
Hopman
Wilma M
WM
Akhtar-Danesh
Noori
N
Anastassiades
Tassos
T
Pickard
Laura
L
Kennedy
Courtney C
CC
Prior
Jerilynn C
JC
Olszynski
Wojciech P
WP
Davison
Kenneth S
KS
Goltzman
David
D
Thabane
Lehana
L
Gafni
Amiran
A
Papadimitropoulos
Emmanuel A
EA
Brown
Jacques P
JP
Josse
Robert G
RG
Hanley
David A
DA
Adachi
Jonathan D
JD
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
D000697:Central Nervous System Stimulants; D002110:Caffeine