Little is known about long-term excess mortality of following fragility fractures other than hip and vertebral fractures. This nationwide, register-based follow-up study included all Danish individuals aged 50+ years who experienced fragility fractures in 2001. Death was ascertained from the Danish death register until 2011. We used relative survival ratio (RSR) to examine excess deaths attributable to individual types of fracture, taking into account time-related mortality changes in the background population.
There were 9,500 men (aged 67± 12 years) and 21,000 women (72± 13) with a first fragility fracture in 2001 followed by 3,198 and 6,589 deaths, respectively. Significant excess mortality was observed following all proximal and lower leg fractures (Table). The majority of deaths occurred within the first year post-fracture and then gradually declined. Hip fractures were associated with the highest excess mortality (1-year RSR of 0.67 and 0.80, ~ excess mortality of 33% and 20% in men and women, respectively). Excess mortality at one year after other femur or pelvic fracture was 20-25%, compared with 10% following vertebral, 5-10% following humerus, rib and clavicle, and 3% following lower leg fractures. A significant, although smaller excess mortality was still observed until approximately 10, 7 and 5 years after hip, femur and other proximal fractures. For every 3 men and 5 women with a hip or femur fracture one extra death occurred above expected in the first year post-fracture, compared with one extra death for 48 men and 33 women with lower leg fracture.
Using a novel, robust technique examining mortality at precise time intervals following fracture, excess mortality for 5 years post-fracture was found for virtually all incident proximal and lower leg fractures. This study highlights the important contribution of a wide variety of fragility fractures on early excess mortality, and thus the need for early intervention.