NEW YORK (Reuters Health) – Otherwise healthy older women who fracture their hip face an increased risk for dying prematurely, new research suggests.

“Our study was able to isolate the effects of hip fracture from health conditions by examining the risk of death after hip fracture in women who were in excellent health,” first author Dr. Erin S. LeBlanc of the Center for Health Research, Kaiser Permanente Northwest in Portland, Oregon, told Reuters Health.

“This is one of the first studies to determine that the hip fracture itself puts women at greater risk of early death,” Dr. LeBlanc pointed out.

“Other studies concluded that the increased death risk was due to underlying health conditions, but we controlled for these health conditions and determined that there is something about the hip fracture itself that increases the risk for death within the first year,” she said.

The findings were published September 26 in Archives of Internal Medicine.

Dr. Michael Herson, who was not involved in the study, told Reuters Health: “We used to presume that it was the general ill-health of a patient that increased the mortality rate in people who have had a hip fracture. This study shows that the mortality rate is also substantially higher in healthy people who fracture a hip.”

“Following a hip fracture, we will need to pay close attention to trying to modify any and all risk factors for dying,” said Dr. Herson, who is chief of endocrinology at Kaiser Permanente Northwest in Portland. “We don’t know exactly what these are, but it is reasonable to assume that a lot of this will be due to reduced mobility (i.e. blood clots and pneumonia).

Dr. LeBlanc’s findings stem from 5,580 women aged 65 and older who were followed for an average of 14.4 years as part of Study of Osteoporotic Fractures, a large community-based, multicenter study. A total of 1,116 women with hip fracture were selected and each was matched with four control participants of the same age who did not have hip fracture (4,464 controls in all).

Overall, hip fracture cases had about a 2-fold increased risk of dying in the year after the fracture compared with controls (16.9% vs. 8.4%; adjusted odds ratio [OR] 2.4).

By age group, the researchers report that women aged 65 to 69 years had a 5-fold increased risk of death in the first year after hip fracture compared to their age-matched peers without hip fracture (16.3% vs. 3.7%: adjusted OR 5.0).

The risk of death was increased 2-fold in women 70 to 79 years old with hip fracture (16.5% vs. 8.9% for controls; OR 2.4).

To examine the effect of health status, Dr. LeBlanc’s team examined a healthy older subset of 960 women aged 80 and older who were in good or excellent health at the 10-year follow-up visit.

These women had nearly a 3-fold increased risk of dying in the year after hip fracture even though they were “exceptionally healthy,” Dr. LeBlanc said. Death rates were 15.1% with hip fracture compared with 7.2% without (adjusted OR, 2.8).

“We believe this increased risk of death in the exceptionally healthy over the age of 80 and in the 65 to 69 year old women suggests it is the hip fracture itself that is putting women at risk of an early death,” Dr. LeBlanc said.

After the first year, survival of hip fracture patients and controls was similar except in those aged 65 to 69, who continued to have increased risk of early death, the investigators note.

Clearly, efforts to prevent hip fracture are “very important,” Dr. LeBlanc concluded.

“Elderly women and those younger women who are at high risk of fractures should be counseled about how to keep their bones as healthy as possible and how to keep from falling,” she advised.

“For example, health providers can advise women to get adequate calcium and vitamin D, to be active, to avoid smoking, and to limit their alcohol intake. Health care providers could be a key resource for reminding women to make sure their houses are free of fall risks (such as electrical cords, slippery floors, poor lighting) and for ensuring they are having regular vision checks,” she added.

Reference:
Hip Fracture and Increased Short-term but Not Long-term Mortality in Healthy Older Women
Arch Intern Med. Published online September 26, 2011.