Background Fragility hip fracture is associated with increased mortality both in short and long term. Apart from age and gender, risk factors for hip fracture mortality are not sufficiently understood and only few studies have explored the predictors of hip fracture mortality .
Objectives To study risk factors associated with increased mortality in a prospectively recruited cohort of fragility hip fracture patients.
Methods Fragility hip fracture patients aged >50 years admitted to a county hospital in Southern Norway between 2004 and 2005 were consecutively identified and invited for assessment at the osteoporosis centre. As part of clinical routine data was collected by using questionnaires (e.g. demographics, risk factors for osteoporosis, medications and co-morbidities). Standardized bone density measurements at lumbar spine and hip were performed by 4 trained nurses by using dual energy x-ray absorptiometry. Bone density was expressed as T-scores (SD). Osteoporosis was defined as T-score ≤ -2.5 at lumbar spine and/or hip .
Categorical variables were compared by chi-square test. A logistic regression analysis model was used to identify significant predictors of mortality in the fragility hip fracture patients with death as the dependent variable and statistically significant variables in bivariate analysis as the explanatory variables up to 5 years after fracture. All the analyses were performed using the SPSS version 17.0 (SPSS, Chicago, IL, USA). Statistical significance was defined as p<0.05.
Results A total of 432 hip fracture patients (129 men and 303 women) were prospectively identified. Among them 136 (44 men and 92 females) patients [mean age 84 yrs. (SD 7.9)] were not assessed and 296 (85 men and 211 women) patients [mean age 80.7 (SD 9.1)] were assessed at the Osteoporosis center. After 5 years follow up a statistically significant difference in mortality was found between those assessed [58 males (68.2%) and 91 females (43.1%)] and those not assessed at the osteoporosis center [39 males (88.6%) and 75 (78.3%)] for females, p<0.0001.
In bivariate analysis, variables significantly associated with increased mortality included indoor activity, osteoporosis, restricted mobility, stroke, dementia, visual impairment, older age > 80 years and male gender.
In table 1 the results from the logistic regression model are displayed.
Conclusions Male gender, older age and dementia were identified as strong predictors of mortality. Osteoporosis was also found to be independently associated with increased risk of dying. This is of great interest as treatment with bisphosphonates has been shown not only to reduce fractures but also mortality.
Gonzalez-Rozas M, Perez-Castrillon JL, Gonzalez-Sagrado M, Ruiz-Mambrilla M, Garcia-Alonso M (2012) Risk of mortality and predisposing factors after osteoporotic hip fracture: a one-year follow-up study. Aging Clin Exp Res 24: 181-187.
(1993) Consensus development conference: diagnosis, prophylaxis, and treatment of osteoporosis. Am J Med 94: 646-650.
Disclosure of Interest None Declared
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