Bone Biology Division, Garvan Institute of Medical Research, Sydney, Australia.
Institute of Public Health, United Arab Emirates University, Al Ain, UAE.
Osteoporos Int. 2020 Jan;31(1):119-130. doi: 10.1007/s00198-019-05174-5. Epub 2019 Oct 26.
Less is known about the impact of non-hip non-vertebral fractures (NHNV) on early death. This study demonstrated increased risk of dying following hip and NHNV fractures which was further increased by a subsequent fracture. This highlights the importance of early intervention to prevent both initial and subsequent fractures and improve survival.
Osteoporotic fractures are a major health concern. Limited evidence exists on their impact on mortality in ageing populations. This study examined the contribution of initial fracture type and subsequent fracture on mortality in a Norwegian population that has one of the highest rates of fractures.
The Tromsø Study is a prospective population-based cohort in Norway. Women and men aged 50+ years were followed from 1994 to 2010. All incident hip and non-hip non-vertebral (NHNV) fractures were registered. NHNV fractures were classified as either proximal or distal. Information on self-reported co-morbidities, lifestyle factors, general health and education level was collected. Multivariable Cox models were used to quantify mortality risk with incident and subsequent fractures analysed as time-dependent variables.
Of 5214 women and 4620 men, 1549 (30%) and 504 (11%) sustained a fracture, followed by 589 (38%) and 254 (51%) deaths over 10,523 and 2821 person-years, respectively. There were 403 (26%) subsequent fractures in women and 68 (13%) in men. Hip fracture was associated with a two-fold increase in mortality risk (HR 2.05, 95% CI 1.73-2.42 in women and 2.49, 95% CI 2.00-3.11 in men). Proximal NHNV fractures were associated with 49% and 81% increased mortality risk in women and men (HR 1.49, 95% CI 1.21-1.84 and 1.81, 95% CI 1.37-2.41), respectively. Distal NHNV fractures were not associated with mortality. Subsequent fracture was associated with 89% and 77% increased mortality risk in women and men (HR 1.89, 95% CI 1.52-2.35 and 1.77, 95% CI 1.16-2.71), respectively.
Hip, proximal NHNV and subsequent fractures were significantly associated with increased mortality risk in the elderly, highlighting the importance of early intervention.
骨质疏松性骨折是一个主要的健康关注点。关于其对老龄化人群死亡率的影响，证据有限。本研究在挪威一个骨折发生率最高的人群中，检查了初始骨折类型和随后骨折对死亡率的贡献。
特罗姆瑟研究是挪威的一项前瞻性基于人群的队列研究。50 岁及以上的女性和男性从 1994 年随访到 2010 年。所有新发髋部和非髋部非椎体（NHNV）骨折均有登记。NHNV 骨折分为近端或远端。收集了自我报告的合并症、生活方式因素、总体健康状况和教育水平的信息。多变量 Cox 模型用于量化死亡率风险，将新发和随后的骨折作为时间依赖性变量进行分析。
在 5214 名女性和 4620 名男性中，1549 人（30%）和 504 人（11%）发生了骨折，随后分别有 589 人（38%）和 254 人（51%）在 10523 和 2821 人年死亡。女性中有 403 例（26%）发生了随后的骨折，男性中有 68 例（13%）。髋部骨折使女性的死亡率风险增加了两倍（HR 2.05，95%CI 1.73-2.42；男性为 2.49，95%CI 2.00-3.11）。近端 NHNV 骨折使女性和男性的死亡率风险分别增加了 49%和 81%（HR 1.49，95%CI 1.21-1.84 和 1.81，95%CI 1.37-2.41）。远端 NHNV 骨折与死亡率无关。随后的骨折使女性和男性的死亡率风险分别增加了 89%和 77%（HR 1.89，95%CI 1.52-2.35 和 1.77，95%CI 1.16-2.71）。
髋部、近端 NHNV 和随后的骨折与老年人死亡率的增加显著相关，这突显了早期干预的重要性。
