title: Long-term mortality following fractures at different skeletal sites: a population-based cohort study.
abstract: Adjusting for age, sex, and precipitating cause, the relative risk of death was increased following fractures at most skeletal sites.
  
  
  BACKGROUND
  This study aims to determine long-term survival following fractures due to any cause at each skeletal site.
  
  
  METHODS
  In a historical cohort study, 2,901 Olmsted County, MN, USA, residents ≥35 years old who experienced any fracture in 1989-1991 were followed passively for up to 22 years for death from any cause. Standardized mortality ratios (SMRs) compared observed to expected deaths.
  
  
  RESULTS
  During 38,818 person-years of follow-up, 1,420 deaths were observed when 1,191 were expected (SMR, 1.2; 95 % CI, 1.1-1.3). The overall SMR was greatest soon after fracture, especially among the men, but remained elevated for over a decade thereafter. Adjusting for age and sex, relative death rates were greater for pathological fractures and less for severe trauma fractures compared to the fractures due to no more than moderate trauma. In the latter group, long-term mortality was increased following fractures at many skeletal sites. After further adjustment for precipitating cause, overall SMRs were elevated not only following fractures at the traditional major osteoporotic sites (i.e., distal forearm, proximal humerus, thoracic/lumbar vertebrae, and proximal femur) combined (SMR, 1.2; 95 % CI, 1.1-1.3) but also following all other fracture types combined (SMR 1.2; 95 % CI, 1.1-1.4), excluding the hand and foot fractures not associated with any increased mortality.
  
  
  CONCLUSIONS
  The persistence of increased mortality long after the occurrence of a fracture has generally been attributed to underlying comorbidity, but this needs to be defined in much greater detail if specific opportunities are to be identified for reducing the excess deaths observed.
authors.affiliation: Division of Epidemiology, Department of Health Sciences Research, College of Medicine, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA. melton.j@mayo.edu
authors.forename: L J
authors.initials: LJ
authors.lastname: Melton
authors.forename: S J
authors.initials: SJ
authors.lastname: Achenbach
authors.forename: E J
authors.initials: EJ
authors.lastname: Atkinson
authors.forename: T M
authors.initials: TM
authors.lastname: Therneau
authors.forename: S
authors.initials: S
authors.lastname: Amin
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D050723:Fractures, Bone / Q000209:etiology / Q000401:mortality*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008910:Minnesota / Q000453:epidemiology; D058866:Osteoporotic Fractures / Q000401:mortality; D017678:Sex Distribution; D013997:Time Factors