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Osteoporosis International
Published in: Osteoporosis International 4/2015

01-04-2015 | Original Article

Accelerated bone loss and increased post-fracture mortality in elderly women and men

Authors: D. Bliuc, N. D. Nguyen, D. Alarkawi, T. V. Nguyen, J. A. Eisman, J. R. Center

Published in: Osteoporosis International | Issue 4/2015

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Abstract

Summary

Bone loss, a fracture risk factor, may play a role in post-fracture mortality. We found accelerated bone loss (≥1.31 % bone loss/year for women and ≥1.35 % bone loss/year for men) associated with 44–77 % increased mortality. It remains unclear whether bone loss is a marker or plays a role in mortality.

Introduction

Osteoporotic fractures are associated with increased mortality although the cause is unknown. Bone loss, a risk factor for osteoporotic fracture is also associated with increased mortality, but its role in mortality risk post-fracture is unclear. This study aimed to examine post-fracture mortality risk according to levels of bone loss.

Methods

Community-dwelling participants aged 60+ from Dubbo Osteoporosis Epidemiology Study with incident fractures were followed from 1989 to 2011. Kaplan-Meier survival curves were constructed according to bone loss quartiles. Cox proportional hazard models were used to determine the effect of bone loss on mortality.

Results

There were 341 women and 106 men with ≥2 BMD measurements. The rate of bone loss was similar for women and men (women mean −0.79 %/year, highest bone loss quartile −1.31 %/year; men mean −0.74 %/year, highest quartile −1.35 %/year). Survival was lowest for the highest quartile of bone loss for women (p < 0.005) and men (p = 0.05). When analysed by fracture type, the association of bone loss with mortality was observed for vertebral (highest vs lower 3 quartiles of bone loss, women p = 0.03 and men p = 0.02) and non-hip non-vertebral fractures in women (p < 0.0001). Bone loss did not play an additional role in mortality risk following hip fractures. Importantly, overall, rapid bone loss was associated with 44–77 % increased mortality risk after multiple variable adjustment.

Conclusion

Rapid bone loss was an independent predictor of post-fracture mortality risk in both women and men. The association of bone loss and post-fracture mortality was predominantly observed following vertebral fracture in both women and men and non-hip non-vertebral fracture in women. It remains to be determined whether bone loss is a marker or plays a role in the mortality associated with fractures.
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Metadata
Title
Accelerated bone loss and increased post-fracture mortality in elderly women and men
Authors
D. Bliuc
N. D. Nguyen
D. Alarkawi
T. V. Nguyen
J. A. Eisman
J. R. Center
Publication date
01-04-2015
Publisher
Springer London
Published in
Osteoporosis International / Issue 4/2015
Print ISSN: 0937-941X
Electronic ISSN: 1433-2965
DOI
https://doi.org/10.1007/s00198-014-3014-9

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