Abteilung für Unfallchirurgie, Orthopädie, Plastische und Handchirurgie, Universitätsklinikum Augsburg, Stenglinstraße 2, 86156, Augsburg, Germany.
Eur Geriatr Med. 2021 Feb;12(1):61-68. doi: 10.1007/s41999-020-00392-1. Epub 2020 Sep 18.
The most common osteoporotic fragility fractures are hip, vertebral and upper extremity fractures. An association with increased mortality is widely described with their occurrence. Fracture-specific associated death rates were determined in a 2-year follow-up for patients treated on an orthogeriatric ward. These were compared amongst each other, examined for changes with age and their impact on the relative mortality risk in relation to the corresponding population.
We assessed all patients that were treated in the course of a year on an orthogeriatric ward and suffered from the following injuries: hip (HF), vertebral (VF) and upper extremity fractures (UEF). In a 2-year follow-up it was possible to determine the month of death in the case of the patient's decease. Pairwise comparisons of the three fracture type death rates were performed through Cox-Regression. We stratified the fracture-dependent absolute mortality and age-specific mortality risk (ASMR) for age groups 71-80, 81-90 and 91-95.
Overall, we assessed 240 patients with HF, 96 with VF and 127 with UEF over the span of a year. 1- and 2-year-mortality was: HF: 29.6% a.e. 42.9%, VF: 29.2% a.e. 36.5%, UEF: 20.5% a.e 34.6%. Pairwise comparisons of these mortality values revealed no significant differences. In association with HF and VF, we observed a significant increase of 2-year mortality for the oldest compared to the youngest patients (HF: 60.4% vs. 22.5%; p = 0.028) (VF 70% vs. 14.3%; p = 0.033). The analogue comparison for UEF revealed no relevant difference in age-dependent mortality (40.9% vs. 31.1%; p = 0.784). Common for all fracture types ASMR's were more elevated in the younger patients and decreased with higher age.
The fracture-related mortality in the 2-year follow-up was comparable. We observed a reduction of relative mortality risk in the oldest patients. While a direct influence of fracture on mortality must be supposed, we support the thesis of the fracture rather being an indicator of higher susceptibility of timely death.
最常见的骨质疏松性脆性骨折是髋部、椎体和上肢骨折。其发生与死亡率增加广泛相关。在骨科老年病房治疗的患者进行了为期 2 年的随访，确定了与骨折相关的特定死亡率。在彼此之间进行了比较，检查了年龄变化及其对与相应人群相关的相对死亡率的影响。
我们评估了在骨科老年病房治疗的一年内患有以下损伤的所有患者：髋部（HF）、椎体（VF）和上肢骨折（UEF）。在 2 年的随访中，可以确定患者死亡的月份。通过 Cox 回归对三种骨折类型死亡率进行了两两比较。我们对年龄组 71-80、81-90 和 91-95 进行了骨折依赖性绝对死亡率和年龄特异性死亡率风险（ASMR）的分层。
总体而言，我们在一年内评估了 240 例 HF、96 例 VF 和 127 例 UEF 患者。1 年和 2 年死亡率为：HF：29.6%（均数）42.9%（均数），VF：29.2%（均数）36.5%（均数），UEF：20.5%（均数）34.6%（均数）。对这些死亡率值进行两两比较，没有发现显著差异。与 HF 和 VF 相关，我们观察到与最年轻患者相比，最年长患者的 2 年死亡率显著增加（HF：60.4%比 22.5%；p=0.028）（VF：70%比 14.3%；p=0.033）。对于 UEF 的类似比较，年龄依赖性死亡率没有发现相关差异（40.9%比 31.1%；p=0.784）。所有骨折类型的 ASMR 在年轻患者中均较高，随着年龄的增长而降低。
在 2 年随访中，与骨折相关的死亡率相当。我们观察到最年长患者的相对死亡率风险降低。虽然骨折对死亡率的直接影响必须假定，但我们支持骨折更像是及时死亡高易感性的指标的论点。
