Hip fractures increase mortality five- to eightfold, more so in men

Older adults are five to eight times as likely to die for any reason in the first three months after hip fracture, and although excess annual mortality decreases in the next two years, it does not return to the rate of age-matched peers even after 10 years of follow-up.

Also, at any given age, mortality after hip fracture is higher in men than in women, concluded a meta-analysis.

Researchers conducted the meta-analysis of 578,436 women and 154,276 men with hip fracture. They published results in the March 16 Annals of Internal Medicine.

Chosen studies all included a life-table analysis, and displayed the survival curves of the hip fracture group and age- and sex-matched control groups. Cohorts comprised the general population in 17 studies, Medicare enrollees in three studies, hospital control participants without hip fracture in two studies, and community-dwelling participants without hip fracture in two studies. Survival was documented from one to 15 years after injury.

Time-to-event meta-analyses showed that the relative hazard for all-cause mortality in the first three months after hip fracture was 5.75 (95% CI, 4.94 to 6.67) in women and 7.95 (CI, 6.13 to 10.30) in men. In both sexes, excess mortality after hip fracture depends largely on age, researchers concluded. Life-table methods showed that white women who have a hip fracture at age 80 have excess annual mortality compared to age-matched white women without a fracture of 8%, 11%, 18% and 22% at one, two, five and 10 years after injury, respectively. Men with a hip fracture at age 80 years have excess annual mortality of 18%, 22%, 26% and 20% at one, two, five and 10 years after injury, respectively.

Several factors may contribute to the marked increase in short-term relative mortality risk after hip fracture. These include:

• postoperative events associated with hip surgery, such as pulmonary embolism,
• infectious complications,
• heart failure, or
• cardiovascular or pulmonary complications.

Multiple comorbidities predisposing to fracture, such as dementia, chronic obstructive pulmonary disease, psychiatric conditions, cardiovascular disease, kidney disease and neurologic diseases, could also increase short-term mortality risks and merit further study, the authors said.