Hip Fracture Confers Significantly Greater Mortality Risk in Older Adults Relative to Other Lower Extremity Fractures (Preprint)

2021 ◽  
Author(s):  
Andrea Dimet ◽  
George Golovko ◽  
Stanley Watowich
Keyword(s):  
Older Adults ◽  
Hip Fracture ◽  
Propensity Score ◽  
Lower Extremity ◽  
Elderly Patients ◽  
Propensity Score Matching ◽  
Mortality Risk ◽  
Mortality Rates ◽  
One Year ◽  
Fracture Types

BACKGROUND Hip fracture in older adults is tied to increased mortality risk. Deconvolution of the mortality risk specific to hip fracture from that of various other fracture types has not been performed in recent hip fracture studies, but is critical to determining current unmet needs for therapeutic intervention. OBJECTIVE This study examined whether hip fracture increases the one-year post-fracture mortality rate relative to several other fracture types and determined if dementia or type 2 diabetes (T2D) exacerbates post-fracture mortality risk. METHODS TriNetX Diamond Network data were used to identify elderly patients that suffered a single fracture event of the hip, the upper humerus, or several regions near and distal to the hip between 2010-2019. Propensity-score matching, Kaplan-Meier, and hazard ratio analyses were performed for all fracture groupings relative to hip fracture. One-year post-fracture mortality rates in elderly populations with dementia or T2D were established. RESULTS One-year mortality rates following hip fracture consistently exceeded all other lower extremity fracture groupings as well as the upper humerus. Survival probabilities were dramatically lower in the hip fracture groups even after propensity score-matching cohorts for variety of broad categories of characteristics. Dementia in younger elderly cohorts acted synergistically with hip fracture to exacerbate one-year mortality risk. T2D did not exacerbate one-year mortality risk beyond mere additive effects. CONCLUSIONS Elderly patients post-hip fracture have a significantly decreased survival probability. Greatly increased one-year mortality rates following hip fracture may arise from differences in bone quality, bone density, trauma, concomitant fractures, post-fracture treatments or diagnoses, restoration of pre-fracture mobility, or a combination thereof. The synergistic effect of dementia may suggest detrimental mechanistic or behavioral combinations between these two comorbidities Renewed efforts should focus on modulating the mechanisms behind this heightened mortality risk, with particular attention to mobility and comorbid dementia.

Prerehabilitation alanine aminotransferase blood levels and one-year mortality rates in older adults following hip fracture

2020 ◽  
Vol 43 (3) ◽  
pp. 214-218 ◽  
Author(s):  
Rasekh Kashkosh ◽  
Irina Gringauz ◽  
Jonathan Weissmann ◽  
Gad Segal ◽  
Michael Swartzon ◽  
...  
Keyword(s):  
Older Adults ◽  
Hip Fracture ◽  
Alanine Aminotransferase ◽  
Mortality Rates ◽  
Blood Levels ◽  
One Year

scholarly journals Adherence to anti-osteoporosis medication associated with lower mortality following hip fracture in older adults: a nationwide propensity score-matched cohort study

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Shan-Fu Yu ◽  
Jur-Shan Cheng ◽  
Ying-Chou Chen ◽  
Jia-Feng Chen ◽  
Chung-Yuan Hsu ◽  
...  
Keyword(s):  
Older Adults ◽  
Cohort Study ◽  
Hip Fracture ◽  
Propensity Score ◽  
Survival Rates ◽  
Mortality Rates ◽  
Treated Group ◽  
Osteoporosis Medication ◽  
Good Adherence ◽  
All Cause Mortality

Abstract Background We investigated the association of anti-osteoporosis medication with mortality risk in older adults with hip fractures and evaluated the influence of medication adherence on mortality. Methods We conducted a population-based cohort study and identified a total of 13,123 patients aged 65 years or older with hip fracture from the Taiwan National Health Insurance Database during the period 2001–2010. Individuals with (n = 2092) and without (n = 2092) receiving anti-osteoporosis medication were matched using propensity score matching (1:1 ratio). The 1-, 3- and 5-year survival rates after the index fracture were compared between patients with and without treatment. In the treated group, survival rate was compared between those with good and non-adherence. Good adherence was defined as the medication possession ratio of ≥80% and non-adherence as a ratio < 80%. Results The 1-, 3- and 5-year mortality rates were significantly lower in the treated vs. the non-treated group (all p < 0.0001). In the treated group, the estimated 1-, 3- and 5-year survival rates were higher in those with good adherence than in those with non-adherence (all p < 0.0001). Regarding all-cause mortality, the adjusted hazard ratio in the treated vs. the non-treated group was 0.63 (95% confidence interval 0.58–0.68, p < 0.0001). The good adherence subgroup showed a significantly lower mortality risk than that in the non-adherence subgroup (hazard ratio 0.41, 95% confidence interval 0.32–0.51, p < 0.0001). Conclusions The 1-, 3- and 5-year survival rates were significantly higher in patients receiving anti-osteoporosis medication than in the untreated group. All-cause mortality rates were lower in patients with good adherence to anti-osteoporosis medication.

scholarly journals Dedicated Hip Fracture Lists: Improving the Service Received by Orthopaedic Trauma Patients

2013 ◽  
Vol 95 (3) ◽  
pp. 1-3 ◽  
Author(s):  
SZ Basheer ◽  
DI Wood ◽  
K Shepherd ◽  
JC McGregor-Riley
Keyword(s):  
Hip Fracture ◽  
Elderly Patients ◽  
Hip Fractures ◽  
Femoral Fractures ◽  
Mortality Rates ◽  
Trauma Patients ◽  
Orthopaedic Trauma ◽  
Proximal Femoral Fractures ◽  
One Year ◽  
The Uk

Proximal femoral fractures are the most common injury resulting in acute admission to an orthopaedic trauma ward. Up to 75,000 hip fractures occur per year in the UK and this is projected to rise to around 100,000 per year by 2020. These fractures occur most frequently in frail, elderly patients who have significant co-morbidities and they are consequently associated with high mortality rates of 5–10% at one month and up to 30% at one year following injury.

1497-P: Secular Trends in Incidence and One-Year Mortality Rates of Lower Extremity Amputation in People with Diabetes in Hong Kong between 2001 and 2016

Diabetes ◽  
2020 ◽  
Vol 69 (Supplement 1) ◽  
pp. 1497-P
Author(s):  
HONGJIANG WU ◽  
AIMIN YANG ◽  
ERIC S. LAU ◽  
RONALD C. MA ◽  
ALICE P. KONG ◽  
...  
Keyword(s):  
Hong Kong ◽  
Lower Extremity ◽  
Mortality Rates ◽  
Secular Trends ◽  
Lower Extremity Amputation ◽  
One Year ◽  
Extremity Amputation

scholarly journals Mortality in older adults following a fragility fracture: real-world retrospective matched-cohort study in Ontario

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Jacques P. Brown ◽  
Jonathan D. Adachi ◽  
Emil Schemitsch ◽  
Jean-Eric Tarride ◽  
Vivien Brown ◽  
...  
Keyword(s):  
Cohort Study ◽  
Hip Fracture ◽  
Fragility Fracture ◽  
Mortality Risk ◽  
Real World ◽  
First Year ◽  
Matched Cohort ◽  
Matched Cohort Study ◽  
Fracture Cohort ◽  
One Year

Abstract Background Recent studies are lacking reports on mortality after non-hip fractures in adults aged > 65. Methods This retrospective, matched-cohort study used de-identified health services data from the publicly funded healthcare system in Ontario, Canada, contained in the ICES Data Repository. Patients aged 66 years and older with an index fragility fracture occurring at any osteoporotic site between 2011 and 2015 were identified from acute hospital admissions, emergency and ambulatory care using International Classification of Diseases (ICD)-10 codes and data were analyzed until 2017. Thus, follow-up ranged from 2 years to 6 years. Patients were excluded if they presented with an index fracture occurring at a non-osteoporotic fracture site, their index fracture was associated with a trauma code, or they experienced a previous fracture within 5 years prior to their index fracture. This fracture cohort was matched 1:1 to controls within a non-fracture cohort by date, sex, age, geography and comorbidities. All-cause mortality risk was assessed. Results The survival probability for up to 6 years post-fracture was significantly reduced for the fracture cohort vs matched non-fracture controls (p < 0.0001; n = 101,773 per cohort), with the sharpest decline occurring within the first-year post-fracture. Crude relative risk of mortality (95% confidence interval) within 1-year post-fracture was 2.47 (2.38–2.56) in women and 3.22 (3.06–3.40) in men. In the fracture vs non-fracture cohort, the absolute mortality risk within one year after a fragility fracture occurring at any site was 12.5% vs 5.1% in women and 19.5% vs 6.0% in men. The absolute mortality risk within one year after a fragility fracture occurring at a non-hip vs hip site was 9.4% vs 21.5% in women and 14.4% vs 32.3% in men. Conclusions In this real-world cohort aged > 65 years, a fragility fracture occurring at any site was associated with reduced survival for up to 6 years post-fracture. The greatest reduction in survival occurred within the first-year post-fracture, where mortality risk more than doubled and deaths were observed in 1 in 11 women and 1 in 7 men following a non-hip fracture and in 1 in 5 women and 1 in 3 men following a hip fracture.

Abstract 67: Effects of Single vs Dual Antiplatelet Therapy on Long Term Stroke and Death After Carotid Endarterectomy

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Nathan Belkin ◽  
Alexander S Fairman ◽  
Benjamin M Jackson ◽  
Paul J Foley ◽  
Scott M Damrauer ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Propensity Score ◽  
Carotid Endarterectomy ◽  
Propensity Score Matching ◽  
Antiplatelet Therapy ◽  
Dual Antiplatelet Therapy ◽  
Long Term Effects ◽  
Kaplan Meier ◽  
One Year

Introduction: Current evidence suggests that dual antiplatelet therapy (DAPT) reduces perioperative stroke, but increases bleeding after carotid endarterectomy (CEA). The long term effects of antiplatelet therapy after CEA have yet to be studied. Methods: A retrospective review of patients undergoing CEA in the national Vascular Quality Initiative database (2003-2018) was performed. Based on antiplatelet regimen at discharge, patients were propensity score matched on aspirin monotherapy vs. DAPT. Multivariable logistic regression and Kaplan-Meier analyses were used to investigate the long term effects of antiplatelet regimen on mortality and stroke/TIA. Results: Of the 72,122 patients undergoing CEA, 64.6% were discharged on aspirin, and 35.4% on DAPT. The DAPT group had higher frequencies of comorbidities (COPD, HTN, CHF, smoking, diabetes) as well as atherosclerotic diseases (PAD, CAD, prior PCI, prior CABG). After propensity score matching, two groups of 8,722 patients with comparable comorbidities were formed. While unmatched Kaplan-Meier analysis showed the DAPT cohort to have higher mortality (p=0.001), this difference dissipated after matching. The resultant matched DAPT cohort did not differ from the aspirin group in one year stroke/TIA (1.7% vs. 1.6%, p=0.70), or mortality (3.1% vs. 3.3%, p=0.55). At 5 years, however, patients treated with DAPT did exhibit a mortality benefit (6.4% vs. 7.3%, p=0.02) with multivariable logistic regression identifying DAPT as an independent predictor of reduced mortality (OR 0.94, 95% CI 0.88-0.99, p=0.04). Conclusions: Patients discharged on DAPT after CEA represent a significantly different cohort than those discharged on aspirin monotherapy. After propensity score matching, there was no difference at one year stroke/TIA or mortality outcomes, but DAPT was found to be protective against long-term mortality. Further study is warranted to investigate this finding.

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