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Broken Hip Increases 10-Year Death Risk
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By Michael Smith, North American Correspondent, MedPage Today
Published: March 16, 2010
Reviewed by Dori F. Zaleznik, MD; Associate Clinical Professor of Medicine, Harvard Medical School, Boston and
Dorothy Caputo, MA, RN, BC-ADM, CDE, Nurse Planner | Earn CME/CE credit
for reading medical news
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| Action Points
- Explain to interested patients that this study suggests that, for older patients, the effects of a broken hip may persist for many years, increasing the risk of death during that period.
Among older men and women, a hip fracture increases the risk of death from any cause for at least 10 years after the injury, researchers said.
A meta-analysis showed that the risk of all-cause mortality is increased between five- and eight-fold in the first three months after the fracture, according to Patrick Haentjens, MD, PhD, of the Vrije Universiteit Brussel, in Brussels, and colleagues.
That risk drops substantially during the first two years after the broken hip, but for up to 10 years it remains significantly higher than among uninjured people, Haentjens and colleagues reported in the March 16 issue of Annals of Internal Medicine.
At any time, they also found, the risk of death was greater for men than for women.
The excess risk of death in the few months after a broken hip is well established, Haentjens and colleagues noted, but what happens after that is less clear.
To shed some light on the matter, the researchers looked for prospective cohort studies published from 1957 to May 2009 that contained both a life-table analysis, and survival curves of the hip fracture group and age- and sex-matched controls.
All told, they found 24 articles that looked at 22 unique cohorts of women and 17 unique cohorts of men, 50 or older, as well as age- and sex-matched controls. The cohorts included a total of 578,436 women and 154,276 men with hip fracture.
Analysis showed:
- In the first three months after injury, women with a hip fracture had a relative hazard for death of 5.75, with a 95% confidence interval from 4.94 to 6.67, which was significant at P<0.001.
- In the same time period, men had a relative hazard for death of 7.95, with a 95% confidence interval from 6.13 to 10.30, which was also significant at P<0.001.
- For women, nine to 10 years after the injury, the relative hazard dropped to 1.96, compared with controls, but remained significant at P=0.001.
- For men by that time, the relative hazard was 1.79, significant at P=0.012.
Compared with age-matched women who did not have a fracture, life-table methods showed that women who have a hip fracture at age 80 have excess annual mortality, of 8%, 11%, 18%, and 22% at one, two, five, and 10 years after injury, respectively.
The comparable figures for men were 18%, 22%, 26%, and 20%, the researchers said.
The study has several limitations, the researchers acknowledged, including the possibility of publication bias. Also, studies varied in size, duration of observation, selection of control populations, ascertainment of death, and adjustment for comorbid conditions.
The analysis did not quantify how much of the observed excess mortality is directly attributable to hip fracture, and mortality rates in both populations may vary over time and could bias the estimates.
The generalizability of the findings is limited, the researchers wrote, because the models only included a white U.S. population. Finally, the study was not prospective
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发表于 2010-5-20 22:01:08