Effect of hip fracture on mortality in elderly women: the EPIDOS prospective study.

OBJECTIVES

To assess whether the occurrence of a hip fracture is associated with an increased risk of mortality even after taking into account age and prefracture health status and whether this increased risk of mortality persists beyond the first 6 months after the fracture.

DESIGN

A prospective study of risk factors for hip fracture.

SETTING

Five French areas: Amiens, Lyon, Montpellier, Paris, and Toulouse.

PARTICIPANTS

The cohort consisted of 7,512 volunteer ambulatory women aged 75 and older who were recruited from voter registration lists. Women who had a history of hip fracture or bilateral hip replacement were excluded.

MEASUREMENTS

The baseline examination included a functional and clinical examination and a questionnaire on life style and treatments. Thereafter, women were followed every 4 months for 4 years to record the occurrence of fractures and deaths. A multivariable proportional hazards model was used to determine the association between hip fracture (treated as a time-dependent variable) and mortality, after adjustment for age and baseline health status.

RESULTS

During a mean+/-standard deviation follow-up of 3.9+/-0.9 years, 338 women had a first hip fracture, and their postfracture mortality rate was 112.4 per 1,000 woman-years, compared with 27.3 per 1,000 woman-years for the 6,115 women who did not have any fracture (P<.001). After adjusting for age and baseline health status, women with hip fracture were more than twice as likely to die (95% confidence interval (CI)=1.6-2.8). This increased risk appeared more pronounced in the first 6 months (relative risk (RR)=3.0, 95% CI=1.9-4.7) than after (RR=1.9, 95% CI=1.6-2.2) (P=.09).

CONCLUSION

In ambulatory elderly women, the occurrence of a hip fracture is associated with an increased risk of death, even after prefracture health status is taken into account. Although the effect of the fracture is stronger in the first 6 months, it persists for several years thereafter, which suggests that prevention of hip fracture and improved care after the fracture may contribute to increase life expectancy in addition to preserving quality of life.