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Hip Fracture Confers Significantly Greater Mortality Risk in Older Adults Relative to Other Lower Extremity Fractures
ABSTRACT
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.
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