With a Broken Hip Comes Higher Risk for Dying

TUESDAY Aug. 4, 2009 -- Older people who break a hip have nearly a 25 percent chance of dying in the next five years, a Canadian study has found.

The five-year death rate for those who have a spinal fracture is 16 percent, according to the study, which is reported in the Aug. 4 issue of the Canadian Medical Association Journal.

The study, which included 7,753 people aged 50 and older from all parts of Canada, found that a hip fracture increases the risk of death 3.2-fold and a spinal fracture increases the risk 2.7-fold, said study author George Ioannidis, a health research methodologist at McMaster University in Hamilton, Ontario.

A number of previous studies have outlined the dangers of fractures for older people, Ioannidis said. "The big difference between this study and the others is design," he said. "We had a random selection of the Canadian people, looking at areas with 40 percent of the Canadian population. Other studies have looked at non-randomized samples, from hospitals or specific geographic regions."

Twenty different factors that could influence mortality, and many different fracture types, were considered in the study, Ioannidis said. The most significant relationships were found for hip and spine fractures.

The research effort, called the Canadian Multicentre Osteoporosis Study, focused on the effects of the bone-weakening condition seen in one of every four women older than 50 and one in every eight men of that age.

"I don't think that individuals are completely aware of the consequences of osteoporosis," Ioannidis said. "It causes not only weakening but also death."

One of every six women over 50 will sustain a hip fracture, he said.

All estimates in the study appear to apply to U.S. residents as well as Canadians.

People should start thinking about the possible dangers of osteoporosis as early as age 50, Ioannidis said. "If you are worried about it, you definitely should consult your physician," he said. "We can act early. We have medications that are very effective, and a variety of non-medical interventions to reduce the incidence of falls that cause fractures."

Those non-medical interventions are a specialty of Maureen Ashe, co-author of a commentary accompanying the report, and an investigator at the Centre for Hip Health and Mobility at Vancouver General Hospital and an assistant professor of family practice at the University of British Columbia.

The toll taken by fractures might be greater than reported in the study, Ashe noted. Cognitive impairment and dementia are major risk factors for fall-related fractures, she said, and people with those conditions are difficult to recruit and thus might be under-represented in the study.

Other medical risk factors include worsening vision, decreased sense of balance and possible effects of the multiple medications taken by many older people, she said.

Bone health can be helped, she said, by adequate physical activity.

"But there are both internal and external factors" involved in fractures, she said. "A lot of preventive research has been done about improving a person's environment, such as making sure there is adequate lighting, fastening scatter rugs, providing handrails where necessary."

More information

The U.S. National Institute of Arthritis and Musculoskeletal and Skin Diseases has more on osteoporosis.

Posted: August 2009


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