In:
The Journal of Clinical Endocrinology & Metabolism, The Endocrine Society, Vol. 101, No. 6 ( 2016-06-01), p. 2475-2483
Abstract:
Hip fracture incidence has been declining and life expectancy improving. However, trends of postfracture outcomes are unknown. Objectives: The objective of the study was to compare the refracture risk and excess mortality after osteoporotic fracture between two birth cohorts, over 2 decades. Design: Prospective birth cohorts were followed up over 2 decades (1989–2004 and 2000–2014). Setting: The study was conducted in community-dwelling participants in Dubbo, Australia. Participants: Women and men aged 60–80 years, participating in Dubbo Osteoporosis Epidemiology Study 1 (DOES 1; born before 1930) and Dubbo Osteoporosis Epidemiology Study 2 (DOES 2; born after 1930) participated in the study. Main Outcome Measure: Age-standardized fracture and mortality over two time intervals: (1989–2004 [DOES 1] and 2000–2014 [DOES 2] ) were measured. Results: The DOES 2 cohort had higher body mass index and bone mineral density and lower initial fracture rate than DOES 1, but similar refracture rates [age-standardized refracture rates per 1000 person-years: women: 53 (95% confidence interval [CI] 42–63) and 51 (95% CI 41–60) and men: 53 (95% CI 38–69) and 55 (95% CI 40–71) for DOES 2 and DOES 1, respectively). Absolute postfracture mortality rates declined in DOES 2 compared with DOES 1, mirroring the improvement in general-population life expectancy. However, when compared with period-specific general-population mortality, there was a similar 2.1- to 2.6-fold increased mortality risk after a fracture in both cohorts (age-adjusted standardized mortality ratio, women: 2.05 [95% CI 1.43–2.83] and 2.43 [95% CI 1.95–2.99] and men: 2.56 [95% CI 1.78–3.58] and 2.48 [95% CI 1.87–3.22] for DOES 2 and DOES 1, respectively). Conclusion: Over the 2 decades, despite the decline in the prevalence of fracture risk factors, general-population mortality, and initial fracture incidence, there was no improvement in postfracture outcomes. Refracture rates were similar and fracture-associated mortality was 2-fold higher than expected. These data indicate that the low postfracture treatment rates are still a major problem.
Type of Medium:
Online Resource
ISSN:
0021-972X
,
1945-7197
DOI:
10.1210/jc.2016-1514
Language:
English
Publisher:
The Endocrine Society
Publication Date:
2016
detail.hit.zdb_id:
2026217-6
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