MORTALITY FOLLOWING FRACTURES IN OLDER WOMEN - THE STUDY OF OSTEOPOROTIC FRACTURES

Background: Most investigators have hypothesized that the increase in mortality following osteoporotic fractures reflects poor underlying he alth status in addition to the acute effects of the fracture. Methods: We observed 9704 ambulatory women aged 65 years or older enrolled in the Study of Osteoporotic Fractures. We obtained reports of fractures and deaths every 4 months and reviewed death certificates and hospital discharge summaries. Multivariable proportional hazards models were u sed to determine the association between fractures and age-adjusted mo rtality. Results: During a mean follow-up of 5.9 years, 1737 women had nonspine fractures, with a postfracture mortality rate of 3 per 100 w oman-years, compared with 1.8 per 100 woman-years in those who did not have fractures (P<.001). After adjusting for other factors associated with mortality, women (n=361) with fractures of the hip or pelvis had a 2.4-fold (95% confidence interval, 1.7-3.3) increase in mortality. However, only 9 (14%) of the 64 deaths that occurred after hip or pelv ic fractures were caused or hastened by the fracture. By contrast, 11 (17%) of these deaths seemed to have been a result of chronic conditio ns that had contributed to the hip or pelvic fracture, and 44 (69%) of the deaths were not clearly related to the fracture. Conclusions: Mor tality is increased following several types of fractures in older wome n. Most of the increase following hip and pelvic fractures is due to u nderlying conditions and probably would not be affected by reductions in the incidence of these fractures.