Publications

Abstract

CONTEXT: Following fracture there is increased risk of re-fracture and premature mortality. These outcomes, particularly premature mortality following re-fracture, have not previously been studied together to understand overall mortality risk. OBJECTIVES: This study examined the long-term cumulative incidence of subsequent fracture and total mortality with mortality calculated as a compound risk and separated according to initial and re-fracture. DESIGN: Community dwelling participants aged 60+ from Dubbo Osteoporosis Epidemiology Study with incident fractures, followed prospectively for further fractures and deaths from 1989-2010. OUTCOME MEASURES: Subsequent fracture and mortality ascertained using cumulative incidence competing risk models allowing 4 possible outcomes: death without re-fracture, death following re-fracture, re-fracture but alive and event-free. RESULTS: There were 952 women and 343 men with incident fracture. Within five years following initial fracture, 24% women and 20% men re-fractured; and 26% women and 37% men died without re-fracture. Of those who re-fractured, a further 50% of women and 75% of men died, so total five-year mortality was 39% in women and 51% in men. Excess mortality was 24% in women and 27% in men. While mortality following re-fracture occurred predominantly in the first five years post initial fracture, total mortality (post initial and re-fracture) was elevated for 10 years. Most of the 5-10 year excess mortality was associated with re-fracture. The long term (>10 yr) re-fracture rate was reduced, particularly in the elderly due to their high mortality rate. The 30% alive beyond 10 years post fracture were at low risk of further adverse outcomes. CONCLUSION: Re-fractures contribute substantially to overall mortality associated with fracture. The majority of the mortality and re-fractures occurred in the first 5 years following the initial fracture. However, excess mortality was observed for up to 10 years post fracture, predominantly related to that following re-fracture.