title: Mortality rates after incident non-traumatic fractures in older men and women.
abstract: Non-traumatic fractures at typical osteoporotic sites are associated with increased mortality across all age groups, particularly in men. Furthermore, in certain age subgroups of women and men, this rate remained elevated beyond 5 years for fractures of the hip, vertebrae, humerus, and other sites.
  
  
  BACKGROUND
  Increased mortality rates have been documented following non-traumatic hip, vertebral, and shoulder fractures. However, data are lacking as to the duration of excess mortality and whether there is increased mortality following fractures at other sites. We determined mortality up to 15 years following incident fractures at typical osteoporotic sites.
  
  
  METHODS
  Using healthcare databases for the Province of Manitoba, Canada, we identified individuals 50 years and older with an incident non-traumatic fracture between 1986 and 2007. Each fracture case was matched to three fracture-free controls. Generalized linear models were used to test for trends in mortality and to estimate the relative risk for cases after adjusting for co-morbidity and living arrangements.
  
  
  RESULTS
  During the study period, we identified 21,067 incident fractures in men followed by 10,724 (50.1%) deaths and 49,197 incident fractures in women followed by 22,018 deaths (44.8%). Seventy-six percent of the fractures were at sites other than the hip and vertebrae. After adjustment for age, number of co-morbidities, and level of dependence in living arrangements, the risk of death in cases, relative to controls, was increased in both sexes for hip, vertebral, humerus, wrist (in men only), and other fracture sites. Post-fracture mortality was higher in men than women. Relative mortality was the highest in the younger age groups across the spectrum of fracture sites.
  
  
  CONCLUSIONS
  Fractures at typical osteoporotic sites are associated with increased mortality across all age groups, particularly in men. Better understanding of factors associated with increased post-fracture mortality should inform the development of management strategies.
authors.affiliation: Division of General Internal Medicine, McGill University Health Center (MUHC), 1650 Cedar Ave, Room B2-118, Montreal, QC, H3G 1A4, Canada. suzanne.morin@mcgill.ca
authors.forename: S
authors.initials: S
authors.lastname: Morin
authors.forename: L M
authors.initials: LM
authors.lastname: Lix
authors.forename: M
authors.initials: M
authors.lastname: Azimaee
authors.forename: C
authors.initials: C
authors.lastname: Metge
authors.forename: P
authors.initials: P
authors.lastname: Caetano
authors.forename: W D
authors.initials: WD
authors.lastname: Leslie
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D015331:Cohort Studies; D005260:Female; D005598:Fractures, Spontaneous / Q000209:etiology / Q000401:mortality*; D006620:Hip Fractures / Q000209:etiology / Q000401:mortality*; D006801:Humans; D006810:Humeral Fractures / Q000209:etiology / Q000401:mortality*; D016014:Linear Models; D008297:Male; D008350:Manitoba / Q000453:epidemiology; D008875:Middle Aged; D010024:Osteoporosis / Q000150:complications; D012307:Risk Factors; D012737:Sex Factors; D016103:Spinal Fractures / Q000209:etiology / Q000401:mortality*; D014954:Wrist Injuries / Q000209:etiology / Q000401:mortality*