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Fractures as predictors of excess mortality in the aged—A population-based study with a 12-year follow-up

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Abstract

Introduction and objective The association between fractures and excess mortality in old age is ambiguous. The objective of this study was to analyze the long-term gender-specific association between fractures and mortality among older persons by controlling several survival related confounders. Methods A population-based prospective cohort study in the municipality of Lieto, south-western Finland. Data on health, health behaviour, fractures, and mortality in 482 men and 695 women aged 65 or older was collected from 1991 until 2002. The Cox Proportional Hazards regression model with fractures as time-dependent variables was used in the analyses. Results During the 12-year follow-up, 295 (25%) persons sustained at least one fracture. Sustaining any kind of fracture was related to excess mortality both in men (age-adjusted Hazards Ratio, HR 2.2, 95% confidence intervals, CI 1.6–3.1) and in women (HR 1.6, 95% CI 1.3–2.1). In the multivariate analyses, hip fractures in men (HR 8.1, 95% CI 4.4–14.9) and in women (HR 3.0, 95% CI 1.9–4.9), and proximal humerus fractures in men (HR 5.4, 95% CI 1.6–17.7) were related to increased mortality. Conclusion A hip fracture was a powerful independent predictor of long-term excess mortality in both genders but the risk in men was more than 2-fold compared to women. Proximal humerus fractures were associated with increased mortality in men. Actions to improve prevention, acute care and rehabilitation of fractures are needed in order to reduce excess mortality in older people.

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Abbreviations

ADL:

Activities of daily living

BMI:

Body mass index

HR:

Hazards ratio

IADL:

Instrumental activities of daily living

ICD-10:

International classification of diseases 10th version

kPa:

kiloPascals

MMSE:

Mini-mental state examination

SD:

Standard deviation

ZSDS:

Zung self-rating depression scale

95% CI:

95% Confidence Interval

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Acknowledgements

This study was supported by the Finnish Cultural Foundation, Emil Aaltonen Foundation, grants from the Hospital District of Southwest Finland and Lieto Health Centre, and the scholarship fund of the Ageing, Wellbeing and Technology graduate school.We are indebted to all those persons who attended data collection in the Lieto study, and especially to Jukka Saukkoriipi for technical assistance in biostatistics.

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Authors and Affiliations

  1. Department of Family Medicine, University of Turku, Lemminkäisenkatu 1, FI-20014, Turku, Finland

    Maarit Piirtola, Minna Löppönen, Ismo Räihä, Raimo Isoaho & Sirkka-Liisa Kivelä

  2. Härkätie Health Centre, Lieto, Finland

    Maarit Piirtola & Minna Löppönen

  3. Department of Biostatistics, University of Turku, Lemminkäisenkatu 1, FI-20014, Turku, Finland

    Tero Vahlberg

  4. Pori Health Centre, Pori, Finland

    Ismo Räihä & Raimo Isoaho

  5. Department of Internal Medicine, Turku City Hospital, Turku, Finland

    Ismo Räihä

  6. Nordic School of Public Health, Gothenburg, Sweden

    Raimo Isoaho

  7. Satakunta Central Hospital, Pori, Finland

    Sirkka-Liisa Kivelä

  8. Unit of Family Medicine, Turku University Hospital, Turku, Finland

    Sirkka-Liisa Kivelä

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  1. Maarit Piirtola
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Correspondence to Maarit Piirtola.

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Piirtola, M., Vahlberg, T., Löppönen, M. et al. Fractures as predictors of excess mortality in the aged—A population-based study with a 12-year follow-up. Eur J Epidemiol 23, 747–755 (2008). https://doi.org/10.1007/s10654-008-9289-4

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