LONG-TERM SURVIVAL AND FRACTURE RISK AFTER HIP FRACTURE: A 22-YEAR FOLLOW-UP STUDY IN 263 MEN

Abstract

Aim: Hip fracture is the most devastating outcome of osteoporosis with high early mortality. Less is known about men in terms of long-term survival and fracture risk, information of outmost importance in terms of strategies for fracture prevention. The aim of this study was to evaluate long-term survival, new fractures and residual life time risk of fracture in a cohort of men with hip fracture in different ages. This is the first study with a follow-up above 10 years.

Methods: All men above 20 yrs of age suffering a hip fracture 1984–1985 in Malmö, Sweden were identified and followed up to 22 years or death. All new radiographic examinations related to musculoskeletal trauma with or without fracture were individually registered. Survival and fractures were evaluated in 5-year age bands and age-groups (< 75, 75–84 and ≥85 years). Kaplan Meier survival analyses were used to evaluate mortality and fracture risk.

Results: 263 men (74.2 yrs, range 33–101) with an index hip fracture due to low energy trauma were identified. 56% had cervical fractures and 44% trochanteric with 6% having concomitant fractures. 10 % had suffered a previous hip fracture. After 22 years 94% were dead; 32 % within 1 yr, 62% within 5 yrs and 79% within 10yrs. Mean age at death was 80.1 yr (range 41–101), equal to a mean of 5.8 yrs above the mean age for fracture. The 50% survival in respectively age groups < 75, 75–84 and ≥ 85 years was 7 yrs, 2 yrs and 3 months. 74/263 (28%) suffered totally 131 fractures (1.8, range 1–7 fractures/patient) at 121 occasions. The majority suffered only a new fracture at one occasion (n=48, 65%). 14% of the fracture occasions occurred within 1 yr and half of the fractures occurred within 3.2 yrs. Mortality adjusted life time risk of fracture was 62% and 10-year risk of fracture was 47%.

Conclusion: In this study we report fracture risk and mortality in a residual life time perspective in men after hip fracture. Men suffer hip fractures earlier in life and have, compared to women from the same cohort, higher early mortality (32% resp 21% (1 yr)) and lower residual lifetime risk of fracture (28% resp 45%)¹. The high early mortality probably mirrors a higher morbidity among male hip fracture patients. The consequence is that fracture preventing strategies need to consider both gender, age and mortality.