title: Population-Wide Impact of Non-Hip Non-Vertebral Fractures on Mortality.
abstract: Data on long-term consequences of non-hip non-vertebral (NHNV) fractures, accounting for approximately two-thirds of all fragility fractures, are scanty. Our study aimed to quantify the population-wide impact of NHNV fractures on mortality. The national population-based prospective cohort study (Canadian Multicentre Osteoporosis Study) included 5526 community dwelling women and 2163 men aged 50 years or older followed from July 1995 to September 2013. Population impact number was used to quantify the average number of people for whom one death would be attributable to fracture and case impact number to quantify the number of deaths out of which one would be attributable to a fracture. There were 1370 fragility fractures followed by 296 deaths in women (mortality rate: 3.49; 95% CI, 3.11 to 3.91), and 302 fractures with 92 deaths in men (5.05; 95% CI, 4.12 to 6.20). NHNV fractures accounted for three-quarters of fractures. In women, the population-wide impact of NHNV fractures on mortality was greater than that of hip and vertebral fractures because of the greater number of NHNV fractures. Out of 800 women, one death was estimated to be attributable to a NHNV fracture, compared with one death in 2000 women attributable to hip or vertebral fracture. Similarly, out of 15 deaths in women, one was estimated to be attributable to a NHNV fracture, compared with one in over 40 deaths for hip or vertebral fracture. The impact of forearm fractures (ie, one death in 2400 women and one out of 42 deaths in women attributable to forearm fracture) was similar to that of hip, vertebral, or rib fractures. Similar, albeit not significant, results were noted for men. The study highlights the important contribution of NHNV fractures on mortality because many NHNV fracture types, except for the most distal fractures, have serious adverse consequences that affect a significant proportion of the population. © 2017 American Society for Bone and Mineral Research.
authors.affiliation: Osteoporosis and Bone Biology, Garvan Institute of Medical Research, Sydney, Australia.
authors.forename: Thach
authors.initials: T
authors.lastname: Tran
authors.affiliation: Osteoporosis and Bone Biology, Garvan Institute of Medical Research, Sydney, Australia.
authors.forename: Dana
authors.initials: D
authors.lastname: Bliuc
authors.affiliation: Department of Family Medicine, Research School Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands.
authors.forename: Tineke
authors.initials: T
authors.lastname: van Geel
authors.affiliation: Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Jonathan D
authors.initials: JD
authors.lastname: Adachi
authors.affiliation: Canadian Multicentre Osteoporosis Study (CaMos) National Coordinating Centre, McGill University, Montreal, Quebec, Canada.
authors.forename: Claudie
authors.initials: C
authors.lastname: Berger
authors.affiliation: Department of Internal Medicine, Subdivision of Rheumatology, Research School Nutrim, Maastricht University Medical Center, Maastricht, The Netherlands.|Department of Internal Medicine, VieCuri Medical Centre of Noord-Limburg, Venlo, The Netherlands.
authors.forename: Joop
authors.initials: J
authors.lastname: van den Bergh
authors.affiliation: Osteoporosis and Bone Biology, Garvan Institute of Medical Research, Sydney, Australia.|Clinical School, St Vincent's Hospital, Sydney, Australia.|Faculty of Medicine, University of New South Wales, Sydney, Australia.|Clinical Translation and Advanced Education, Garvan Institute of Medical Research, Sydney, Australia.|School of Medicine Sydney, University of Notre Dame Australia, Sydney, Australia.
authors.forename: John A
authors.initials: JA
authors.lastname: Eisman
authors.affiliation: Department of Internal Medicine, Subdivision of Rheumatology, Research School Care and Public Health Research Institute (CAPHRI), Maastricht University Medical Center, Maastricht, The Netherlands.|Biomedical Research Institute, University Hasselt, Hasselt, Belgium.
authors.forename: Piet
authors.initials: P
authors.lastname: Geusens
authors.affiliation: Department of Medicine, McGill University, Montreal, Quebec, Canada.
authors.forename: David
authors.initials: D
authors.lastname: Goltzman
authors.affiliation: Department of Medicine, University of Calgary, Calgary, Alberta, Canada.
authors.forename: David A
authors.initials: DA
authors.lastname: Hanley
authors.affiliation: Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Robert G
authors.initials: RG
authors.lastname: Josse
authors.affiliation: Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada.
authors.forename: Stephanie M
authors.initials: SM
authors.lastname: Kaiser
authors.affiliation: Faculty of Medicine, Memorial University, St. John's, Newfoundland, Canada.
authors.forename: Christopher S
authors.initials: CS
authors.lastname: Kovacs
authors.affiliation: School of Public Health, University of Minnesota, Minneapolis, MN, USA.
authors.forename: Lisa
authors.initials: L
authors.lastname: Langsetmo
authors.affiliation: Department of Medicine and Endocrinology, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Jerilynn C
authors.initials: JC
authors.lastname: Prior
authors.affiliation: Osteoporosis and Bone Biology, Garvan Institute of Medical Research, Sydney, Australia.|Faculty of Medicine, University of New South Wales, Sydney, Australia.
authors.forename: Tuan V
authors.initials: TV
authors.lastname: Nguyen
authors.affiliation: Osteoporosis and Bone Biology, Garvan Institute of Medical Research, Sydney, Australia.|Clinical School, St Vincent's Hospital, Sydney, Australia.|Faculty of Medicine, University of New South Wales, Sydney, Australia.
authors.forename: Jacqueline R
authors.initials: JR
authors.lastname: Center
mesh_terms: D000368:Aged; D002170:Canada / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D050723:Fractures, Bone / Q000401:mortality*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012737:Sex Factors
keywords: AGING; EPIDEMIOLOGY; PRACTICE/POLICY-RELATED ISSUES