title: Hip fracture in men-survival and subsequent fractures: a cohort study with 22-year follow-up.
abstract: OBJECTIVE
  To evaluate the influence of age on survival and risk of subsequent fracture in men with hip fracture, applying a residual lifetime perspective.
  
  
  METHODS
  Retrospective cohort study with 22-year follow-up.
  
  
  METHODS
  Skåne University Hospital, Malmö, Sweden.
  
  
  METHODS
  Men aged 60 and older (N = 226) with an index hip fracture during 1984/85.
  
  
  METHODS
  Twenty-two-year survival (mortality) and risk of new fractures evaluated in 5-year age bands and age groups (<75, 75-84, ≥ 85).
  
  
  RESULTS
  Mean age was 78 ± 9. Mortality at 22 years was 98%. Survivors were all younger than 75 at inclusion. Mortality was dependent on age at all time points (18%, 38%, 69% at 1 year, increasing to 71%, 93%, 100% by 10 years in <75, 75-84, ≥ 85, respectively). Median survival was 5.4 years, 2.0 years, and 3 months, respectively, in these age groups, and 33%, 27%, and 13% of each age-group sustained subsequent fractures, generally within 5 years. Overall 10-year fracture risk was 29% (95% confidence interval (CI)=19-38%), increasing to 44% (95% CI=30-58%) when adjusted for mortality. Residual lifetime risk of new fracture was 33% (95% CI=23-43%), and mortality-adjusted risk was 63% (95% CI=45-81%). Participants younger than 75 at index hip fracture were at greatest risk of new fracture (hazard ratio=2.7, 95% CI=1.1-6.4, P=.03).
  
  
  CONCLUSIONS
  Almost one-third of men with hip fracture have subsequent fractures during their remaining lifetime. Time at risk is highly dependent on age. Most new fractures occur in relatively younger men and within 5 years, whereas most aged 75 and older die before experiencing a new fracture.
authors.affiliation: Clinical and Molecular Osteoporosis Research Unit, Department of Clinical Sciences, Lund University, Lund, Sweden. my.von_friesendorff@med.lu.se
authors.forename: My
authors.initials: M
authors.lastname: von Friesendorff
authors.forename: Fiona E
authors.initials: FE
authors.lastname: McGuigan
authors.forename: Jack
authors.initials: J
authors.lastname: Besjakov
authors.forename: Kristina
authors.initials: K
authors.lastname: Akesson
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D005500:Follow-Up Studies; D050723:Fractures, Bone / Q000453:epidemiology*; D006620:Hip Fractures / Q000453:epidemiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D013548:Sweden / Q000453:epidemiology