Department of Surgical Sciences, Section of Orthopaedics, Uppsala University, Uppsala, Sweden; Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden.
J Bone Miner Res. 2014 Feb;29(2):424-31. doi: 10.1002/jbmr.2029.
Several studies have shown a long-lasting higher mortality after hip fracture, but the reasons for the excess risk are not well understood. We aimed to determine whether a higher mortality after hip fracture exists when controlling for genetic constitution, shared environment, comorbidity, and lifestyle by use of a nationwide cohort study in hip fracture discordant monozygotic twins. All 286 identical Swedish twin pairs discordant for hip fracture (1972 to 2010) were identified. Comorbidity and lifestyle information was retrieved by registers and questionnaire information. We used intrapair Cox regression to compute multivariable-adjusted hazard ratios (HRs) for death. During follow-up, 143 twins with a hip fracture died (50%) compared with 101 twins (35%) without a hip fracture. Through the first year after hip fracture, the rate of death increased fourfold in women (HR = 3.71; 95% confidence interval [CI] 1.32-10.40) and sevenfold in men (HR = 6.67; 95% CI 1.47-30.13). The increased rate in women only persisted during the first year after hip fracture (HR after 1 year = 0.99; 95% CI 0.66-1.50), whereas the corresponding HR in men was 2.58 (95% CI 1.02-6.62). The higher risk in men after the hip fracture event was successively attenuated during follow-up. After 5 years, the hazard ratio in men with a hip fracture was 1.19 (95% CI 0.29-4.90). On average, the hip fracture contributed to 0.9 years of life lost in women (95% CI 0.06-1.7) and 2.7 years in men (95% CI 1.7-3.7). The potential years of life lost associated with the hip fracture was especially pronounced in older men (>75 years), with an average loss of 47% (95% CI 31-61) of the expected remaining lifetime. We conclude that both women and men display a higher mortality after hip fracture independent of genes, comorbidity, and lifestyle.
几项研究表明，髋部骨折后死亡率持续升高，但导致这种风险增加的原因尚不清楚。我们旨在通过一项全国性的髋部骨折同卵双胞胎队列研究，确定在控制遗传构成、共同环境、合并症和生活方式的情况下，髋部骨折后是否存在更高的死亡率。共确定了 286 对瑞典同卵双胞胎，其中 1972 年至 2010 年间有 143 对发生髋部骨折（143 对中有 1972 年至 2010 年间发生髋部骨折）。通过登记和问卷调查获取合并症和生活方式信息。我们使用配对 Cox 回归计算多变量调整后的死亡风险比（HR）。在随访期间，143 名髋部骨折的双胞胎中有 143 名（50%）死亡，而 101 名（35%）无髋部骨折的双胞胎中有 101 名死亡。髋部骨折后第一年，女性死亡率增加了四倍（HR=3.71；95%置信区间 [CI] 1.32-10.40），男性增加了七倍（HR=6.67；95% CI 1.47-30.13）。女性的增长率仅在髋部骨折后第一年持续（HR 1 年后=0.99；95% CI 0.66-1.50），而男性的相应 HR 为 2.58（95% CI 1.02-6.62）。男性髋部骨折事件后的高风险在随访过程中逐渐减弱。5 年后，髋部骨折男性的风险比为 1.19（95% CI 0.29-4.90）。平均而言，女性髋部骨折导致寿命缩短 0.9 年（95% CI 0.06-1.7），男性缩短 2.7 年（95% CI 1.7-3.7）。髋部骨折导致的潜在寿命损失在年龄较大的男性（>75 岁）中尤其明显，预期剩余寿命平均减少 47%（95% CI 31-61）。我们的结论是，女性和男性髋部骨折后死亡率均升高，与遗传、合并症和生活方式无关。
