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The Epidemiology of Mortality after Fragility Fracture in England
Frank de Vries
Maastricht University Medical Centre, The NetherlandsMRC Epidemiology Lifecourse Unit, Southampton
Corinne Klop, Tjeerd van Staa, Cyrus Cooper, Nick Harvey
Clinical Epidemiology
Acknowledgements• This paper has been kindly supported by a project grant
from the National Osteoporosis Society
• Dr de Vries has no conflicts of interest to disclose.
• Klop et al. Osteoporosis International, 8 Oct 2016
Clinical Epidemiology
Background• Established mortality rates after hip and vertebral fracture
UK, 2000-2010• After hip fracture:
– Doubled 1-year risk of mortality– 3 - 4 fold increased in men [1]
[1] Klop C et al. Bone 2014;66:171-77
Clinical Epidemiology
Objective• Update the epidemiology of mortality after fragility fracture,
by– Age– Sex– Major causes of death– Region– Ethnicity– Calendar year
Clinical Epidemiology
Methods• Clinical Practice Research Datalink (2001-2011)• 7% total UK population• Aged 50+• England only• Linked to death certificates• Fractures
– Clinical vertebral, Wrist, Hip, Humerus, Rib, Pelvis• Followed for up to 1 year• Outcome: death
Clinical Epidemiology
Results• 22929 men, mean age 73 years• 59446 women, mean age 76 years
• North West (17%)• Other areas (5%-14%)• North East / East Midlands (3% each)
• 98% Caucasian
• 11,217 deaths
Clinical Epidemiology
Design and PopulationMen
Women
1-year mortality rate after fracture
Clinical Epidemiology
Design and PopulationMen
Women
1-year mortality rate after fracture
Clinical Epidemiology
Design and PopulationMen
Women
1-year mortality rate after fracture
Clinical Epidemiology
Design and PopulationMen
Women
1-year mortality rate after fracture
Clinical Epidemiology
Relative 1-year mortality rates after fragility fracture
Men WomenLondon ReferenceEast Midlands 1.0 1.4Yorkshire 1.2 1.0
Klop et al. Osteoporosis International, 8 Oct 2016
Clinical Epidemiology
Results• Ethnicity
– Elevated 1.8-fold increased risk among black women (versus Caucasian women)
• Secular trends– Unchanged excess mortality post-fracture (2001-2011).
Clinical Epidemiology
Conclusion• 1-year mortality rates after fragility fracture were• Higher
– Elderly– Men– Black women (versus Caucasian)
• Lower– London (women) vs. most other regions
• Comparable– Over calendar time (2001-2011)
Clinical Epidemiology
Conclusion
• Major causes of death included– Cardiovascular disease– Respiratory disease– Malignant neoplasms
• Future research should focus on targeted interventions to reduce mortality after fracture
