Fractures Can Lead to Premature Death in Older People

Osteoporosis is a common condition where bones become weak, affecting both men and women, mainly as they grow older. Osteoporosis results from a loss of bone mass, measured as bone density, and from a change in bone structure. Osteoporosis is more common in older women, mainly non-Hispanic white and Asian women. In the U.S., about 4.5 million women and 0.8 million men over the age of 50 have osteoporosis. Risk factors for developing osteoporosis include a sedentary lifestyle, use of glucocorticoids, smoking and having inflammatory arthritis, among others.

Osteoporosis can increase fracture risk, and falls and fractures due to osteoporosis are a growing concern as the population ages. In fact, one-third of all fall-related deaths are attributed to low bone density. Despite this, according to researchers in the 45 & Up study -- a study of 125,174 women and 113,499 men in New South Wales, Australia -- osteoporosis isn't always well-managed and treated, and they suspect that is because of a lack of awareness about just how dangerous osteoporotic fractures can be.

"Health professionals have been aware for some time that having a hip fracture when you are older increases your risk of dying in one to two years after the fracture, but we have not been so aware that other fractures could increase this risk as well, explains Lyn March, MD, PhD; University of Sydney Liggins Professor of Rheumatology and Musculoskeletal Epidemiology at Kolling Institute of Bone and Joint Research and Sydney's Royal North Shore Hospital. "We embarked on this study to highlight the impact of such fractures."

Dr. March's team obtained initial health information from participants in the study (who were, on average, 63 years old at the time of recruitment between 2006 and 2008 and followed up on average every 5.7 years until their death or December 31, 2013) via questionnaire and linked that information to medical codes signifying fractures that were obtained from emergency department visits as well hospital admissions. Finally, they obtained information on participants through birth, marriage and death registries.

Taking into consideration age, gender, co-existing diseases and conditions and previous fractures, the researchers looked at fractures and deaths among the participants. During the course of the study, 14,827 fractures were reported; 9,145 of these were seen in women, and 5,682 were seen in men. The researchers also noted 15, 621 deaths during the study; 5,604 were in women, and 10,017 were in men.

When looking at death in the group, Dr. March's team noted 15.7 men died for every 1,000 person years in the study, which was calculated by multiplying the number of people in the study by the number of years in the study. Conversely, 7.9 women died for every 1,000 person years. However, these rates went up two-fold when fractures were involved: 33 men and 19 women with fractures died for every 1,000 person years of the study.

The researchers not only noted the increase of death among participants with fractures, they were also able to narrow down the types of fractures that seemed to cause more death. "We were surprised to find that almost all fractures (apart from fingers and toes) in the elderly were associated with increased risk of dying when compared to other men and women of the same age who had not had a fracture," says Dr. March "Common fractures like spinal fractures that cause older people to stoop over, arm, collarbone and wrist fractures from a simple fall, or pelvic fractures from a trip on the stairs or a slip on the ice all increase the risk of the sufferer dying in the next few years."

Given these outcomes, Dr. March's team believes there need to be more studies on the risk of osteoporotic fractures and premature deaths. "This is the largest study of its kind and the first to find the increased risk of dying from such a wide range of fractures including hip, vertebral (spinal) and non-hip non-vertebral (shoulders, wrists, collarbone) fractures while being able to adjust for other potential risks of dying. Our study highlights the need for research into the reasons for this increased risk of dying after fractures and also highlights the need to treat osteoporosis as a serious condition to prevent the fractures from occurring," concludes Dr. March.