title: Mortality after lower extremity fractures in men with spinal cord injury.
abstract: In the United States, there are over 200,000 men with spinal cord injuries (SCIs) who are at risk for lower limb fractures. The risk of mortality after fractures in SCI is unknown. This was a population-based, cohort study of all male veterans (mean age 54.1; range, 20.3-100.5 years) with a traumatic SCI of at least 2 years' duration enrolled in the Veterans Affairs (VA) Spinal Cord Dysfunction Registry from FY2002 to FY2010 to determine the association between lower extremity fractures and mortality. Mortality for up to 5 years was determined. The lower extremity fracture rate was 2.14 per 100 patient-years at risk for at least one fracture. In unadjusted models and in models adjusted for demographic, SCI-related factors, healthcare use, and comorbidities, there was a significant association between incident lower extremity fracture and increased mortality (hazard ratio [HR], 1.38; 95% confidence interval [CI], 1.17-1.63; HR, 1.36; 95% CI, 1.15-1.61, respectively). In complete SCI, the hazard of death after lower extremity fracture was also increased (unadjusted model: HR, 1.46; 95% CI, 1.13-1.89; adjusted model: HR, 1.32; 95% CI, 1.02-1.71). In fully-adjusted models, the association of incident lower extremity fracture with increased mortality was substantially greater in older men (age ≥50 years) for the entire cohort (HR, 3.42; 95% CI, 2.75-4.25) and for those with complete SCI (HR, 3.13; 95% CI, 2.19-4.45), compared to younger men (age <50 years) (entire cohort: HR, 1.42; 95% CI, 0.94-2.14; complete SCI: HR, 1.71; 95% CI, 0.98-3.01). Every additional point in the Charlson comorbidity index was associated with a 10% increase in the hazard of death in models involving the entire cohort (HR, 1.11; 95% CI, 1.09-1.13) and also in models limited to men with complete SCI (HR, 1.10; 95% CI, 1.06-1.15). These data support the concept that both the fracture itself and underlying comorbidities are drivers of death in men with SCI.
authors.affiliation: Veterans Affairs Medical Center, Memphis, TN, USA; Department of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA.
authors.forename: Laura D
authors.initials: LD
authors.lastname: Carbone
authors.forename: Amy S
authors.initials: AS
authors.lastname: Chin
authors.forename: Stephen P
authors.initials: SP
authors.lastname: Burns
authors.forename: Jelena N
authors.initials: JN
authors.lastname: Svircev
authors.forename: Helen
authors.initials: H
authors.lastname: Hoenig
authors.forename: Michael
authors.initials: M
authors.lastname: Heggeness
authors.forename: Lauren
authors.initials: L
authors.lastname: Bailey
authors.forename: Frances
authors.initials: F
authors.lastname: Weaver
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D005500:Follow-Up Studies; D050723:Fractures, Bone / Q000209:etiology / Q000401:mortality; D006801:Humans; D035002:Lower Extremity; D008297:Male; D008875:Middle Aged; D008954:Models, Biological; D012189:Retrospective Studies; D012307:Risk Factors; D013119:Spinal Cord Injuries / Q000150:complications / Q000401:mortality; D014481:United States / Q000453:epidemiology; D014493:United States Department of Veterans Affairs; D014728:Veterans
keywords: COX REGRESSION; FRACTURES; MEN; MORTALITY; SPINAL CORD INJURY; VA SPINAL CORD DYSFUNCTION REGISTRY