title: Accelerated bone loss and increased post-fracture mortality in elderly women and men.
abstract: Bone loss, a fracture risk factor, may play a role in post-fracture mortality. We found accelerated bone loss (≥1.31 % bone loss/year for women and ≥1.35 % bone loss/year for men) associated with 44-77 % increased mortality. It remains unclear whether bone loss is a marker or plays a role in mortality.
  
  
  BACKGROUND
  Osteoporotic fractures are associated with increased mortality although the cause is unknown. Bone loss, a risk factor for osteoporotic fracture is also associated with increased mortality, but its role in mortality risk post-fracture is unclear. This study aimed to examine post-fracture mortality risk according to levels of bone loss.
  
  
  METHODS
  Community-dwelling participants aged 60+ from Dubbo Osteoporosis Epidemiology Study with incident fractures were followed from 1989 to 2011. Kaplan-Meier survival curves were constructed according to bone loss quartiles. Cox proportional hazard models were used to determine the effect of bone loss on mortality.
  
  
  RESULTS
  There were 341 women and 106 men with ≥2 BMD measurements. The rate of bone loss was similar for women and men (women mean -0.79 %/year, highest bone loss quartile -1.31 %/year; men mean -0.74 %/year, highest quartile -1.35 %/year). Survival was lowest for the highest quartile of bone loss for women (p < 0.005) and men (p = 0.05). When analysed by fracture type, the association of bone loss with mortality was observed for vertebral (highest vs lower 3 quartiles of bone loss, women p = 0.03 and men p = 0.02) and non-hip non-vertebral fractures in women (p < 0.0001). Bone loss did not play an additional role in mortality risk following hip fractures. Importantly, overall, rapid bone loss was associated with 44-77 % increased mortality risk after multiple variable adjustment.
  
  
  CONCLUSIONS
  Rapid bone loss was an independent predictor of post-fracture mortality risk in both women and men. The association of bone loss and post-fracture mortality was predominantly observed following vertebral fracture in both women and men and non-hip non-vertebral fracture in women. It remains to be determined whether bone loss is a marker or plays a role in the mortality associated with fractures.
authors.affiliation: Osteoporosis and Bone Biology Program, Garvan Institute of Medical Research, 384 Victoria St., Darlinghurst, NSW, 2010, Australia.
authors.forename: D
authors.initials: D
authors.lastname: Bliuc
authors.forename: N D
authors.initials: ND
authors.lastname: Nguyen
authors.forename: D
authors.initials: D
authors.lastname: Alarkawi
authors.forename: T V
authors.initials: TV
authors.lastname: Nguyen
authors.forename: J A
authors.initials: JA
authors.lastname: Eisman
authors.forename: J R
authors.initials: JR
authors.lastname: Center
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015519:Bone Density / Q000502:physiology; D015897:Comorbidity; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006620:Hip Fractures / Q000401:mortality / Q000503:physiopathology; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009517:New South Wales / Q000453:epidemiology; D010024:Osteoporosis / Q000401:mortality* / Q000503:physiopathology; D015663:Osteoporosis, Postmenopausal / Q000401:mortality / Q000503:physiopathology; D058866:Osteoporotic Fractures / Q000401:mortality* / Q000503:physiopathology; D012307:Risk Factors; D012737:Sex Factors; D016103:Spinal Fractures / Q000401:mortality / Q000503:physiopathology