Excess mortality following a first and subsequent osteoporotic fracture: a Danish nationwide register-based cohort study on the mediating effects of comorbidities
Authors' conclusion
The highest mortality risk was found in the month immediately following both index and subsequent fracture. The combination of index and subsequent fractures at different skeletal sites had a substantial impact on the risk of mortality.
Study context
- Population
- Danish National Patient Registry: patients ≥60 years with incident major osteoporotic fracture (hip, vertebrae, wrist, humerus), 2013–2018, and matched controls
- Participants
- 106,303 vs 1,062,988
- Exposure
- Patients with incident major osteoporotic fracture vs matched controls
- Fracturen = 106,303
- Controlsn = 1,062,988reference
- Outcome
- Mortality following incident and subsequent osteoporotic fractures
Methodological detailsnationwide, controls matched 1:10 on age and sex, Cox regression, mediation analyses
- Nationwide
- Controls matched 1:10 on age and sex
- Cox regression
- Mediation analyses
Main finding
As reported in the abstract
Mortality in the month following index hip fracture
Fracture vs ControlsHazard ratio (95% CI)
Women
10.98(10.23–11.79)
Men
16.40(15.00–17.93)
Observational data: associations, not effects.
Further findings
| Outcome | HR (95% CI) | |
|---|---|---|
| Mortality by index/subsequent fracture type combinationFracturevs Controls | 2.43 (2.12–2.78) | |
| Mortality by index/subsequent fracture type combinationFracturevs Controls | 2.69 (2.04–3.54) | |
| 0.20.5125Hazard ratio (log scale) |
- Mortality by index/subsequent fracture type combination: women, index wrist/subsequent hip fractures (highest HR in women)
- Mortality by index/subsequent fracture type combination: men, index humerus/subsequent hip fractures (highest HR in men)
Mortality by index/subsequent fracture type combination
- Subsequent hip fractures resulted in the highest HRs for all fracture type combinations
Mediators of postfracture mortality
- Pneumonia mediated the largest proportion of mortality; dehydration, urinary tract infection and sepsis were also important factors
Original publication
Excess mortality following a first and subsequent osteoporotic fracture: a Danish nationwide register-based cohort study on the mediating effects of comorbidities. RMD Open. Published 29 November 2023. doi:10.
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