title: High mortality in younger patients with major osteoporotic fractures.
abstract: Data were gathered with regard to mortality after fractures in 1006 younger patients. Results revealed that major osteoporotic fractures of the hip and humerus and drinking alcohol to excess were related to an increased risk of mortality.
  
  
  
  Major osteoporotic fractures are known to be associated with increased mortality in older individuals. It is less clear whether this also applies to younger patients.
  
  
  
  Date were gathered regarding patient demographics, fracture pattern, mechanism of injury, as well as smoking and alcohol intake at the time of injury in consecutive patients aged between 40 and 55 who presented to a UK trauma centre over a 12-month period. Mortality data was taken from the electronic patient records and was cross referenced with data from the General Registrar Office of Scotland. Cox regression analysis was used to identify independent predictors of mortality after adjusting for confounding factors.
  
  
  
  The study cohort consisted of 1006 patients, of which 53% were male. The commonest mechanism of injury was a fall. We obtained complete data regarding mortality for all patients at a median of 5.4 years (inter-quartile range 5.1 to 5.6). During this period, 46 patients were identified as being deceased. The overall standardised mortality ratio for the cohort was substantially increased relative to the age and sex matched general population with a ratio of 3.89 (95% confidence intervals (CI) 1.59 to 6.19). Alcohol excess and fractures involving the humerus and the neck of femur were independent predictors of mortality.
  
  
  
  Young individuals with hip and humerus fractures have a significantly increased mortality risk after their injury relative to the general population. The results of our study suggest that this may be in part due to a high prevalence of alcohol excess.
authors.affiliation: Department of Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, EH16 4SU, UK. robbie1ray1@gmail.com.
authors.forename: R
authors.identifier: http://orcid.org/0000-0002-7411-9720
authors.initials: R
authors.lastname: Ray
authors.affiliation: Department of Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, EH16 4SU, UK.
authors.forename: N D
authors.initials: ND
authors.lastname: Clement
authors.affiliation: Department of Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, EH16 4SU, UK.
authors.forename: S A
authors.initials: SA
authors.lastname: Aitken
authors.affiliation: Department of Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, EH16 4SU, UK.
authors.forename: M M
authors.initials: MM
authors.lastname: McQueen
authors.affiliation: Department of Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, EH16 4SU, UK.
authors.forename: C M
authors.initials: CM
authors.lastname: Court-Brown
authors.affiliation: Centre for Genomic and Experimental medicine, Institute of Genetics and Molecular Medicine, Western General Hospital, University of Edinburgh, Edinburgh, EH4 2XU, UK.
authors.forename: S H
authors.initials: SH
authors.lastname: Ralston
mesh_terms: D000058:Accidental Falls / Q000401:mortality; D000328:Adult; D000367:Age Factors; D000437:Alcoholism / Q000150:complications / Q000401:mortality; D005260:Female; D006620:Hip Fractures / Q000209:etiology / Q000401:mortality; D006801:Humans; D006810:Humeral Fractures / Q000209:etiology / Q000401:mortality; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D058866:Osteoporotic Fractures / Q000209:etiology / Q000401:mortality*; D012307:Risk Factors; D012606:Scotland / Q000453:epidemiology; D012907:Smoking / Q000009:adverse effects / Q000453:epidemiology
keywords: Fractures in younger patients; Mortality after fracture; Predictors of mortality