Postfracture survival in a population-based study of adults aged ≥66 yr: a call to action at hospital discharge.

Postfracture survival rates provide prognostic information but are rarely reported along with other mortality outcomes in adults aged ≥50 yr. The timing of survival change following a fracture also needs to be further elucidated. This population-based, matched-cohort, retrospective database study examined 98 474 patients (73% women) aged ≥66 yr with an index fracture occurring at an osteoporotic site (hip, clinical vertebral, proximal non-hip non-vertebral [pNHNV], and distal non-hip non-vertebral [dNHNV]) from 2011 to 2015, who were matched (1:1) to nonfracture individuals based on sex, age, and comorbidities. All-cause 1- and 5-yr overall survival and relative survival ratios (RSRs) were assessed, and time trends in survival changes were characterized starting immediately after a fracture. In both sexes, overall survival was markedly decreased over 6 yr of follow-up after hip, vertebral, and pNHNV fractures, and as expected, worse survival rates were observed in older patients and males. The lowest 5-yr RSRs were observed after hip fractures in males (66-85 yr, 51.9%-63.9%; ≥86 yr, 34.5%), followed by vertebral fractures in males (66-85 yr, 53.2%-69.4%; ≥86 yr, 35.5%), and hip fractures in females (66-85 yr, 69.8%-79.0%; ≥86 yr, 52.8%). Although RSRs did not decrease as markedly after dNHNV fractures in younger patients, relatively low 5-yr RSRs were observed in females (75.9%) and males (69.5%) aged ≥86 yr. The greatest reduction in survival occurred within the initial month after hip, vertebral, and pNHNV fractures, indicating a high relative impact of short-term factors, with survival-reduction effects persisting over time. Therefore, the most critical period for implementing interventions aimed at improving post-fracture prognosis appears to be immediately after a fracture; however, considering the immediate need for introducing such interventions, primary fracture prevention is also crucial to prevent the occurrence of the initial fracture in high-risk patients.
Competing Interests: E.S. has received consulting fees from Amgen. J.D.A. has received consulting fees from Amgen, Gilead, GlaxoSmithKline, and Paladin; received research funding from Amgen and Radius; and served on speakers bureaus for Amgen, Gilead, and GlaxoSmithKline. J.P.B. has received research support from Mereo BioPharma, Radius Health, and Servier; has served as a consultant for Amgen, Gilead, Paladin, Pfizer, Servier, and Ultragenyx; and has served on speakers bureaus for Amgen. J.-E.T. has led educational workshops for Allergan; received consulting fees from Amgen, Analytica Laser International, AstraZeneca, Bayer, Edwards Lifesciences, the European Commission Initiative on Breast Cancer (ECIBC), Evidera, Flatiron, GSK, Lilly, Merck, Novartis, PCDI Canada, Pfizer Inc., and Roche; and received research funding from Amgen, Assurex/Myriad, AstraZeneca, CSL Behring, Edwards Lifesciences, Novo Nordisk, and Sage. G.V., R.J.W., and N.H. are employees of Amgen and own Amgen stock.
(© The Author(s) 2024. Published by Oxford University Press on behalf of the American Society for Bone and Mineral Research.)