Excess short- and long-term mortality risk following any and hip fractures: a
prospective matched cohort study using exposure density sampling
#MMPMID41162477
Zhang Y
; Zhang K
; Chai L
; Hu X
; Kong W
; Wang W
; Zhang D
; Fan J
Sci Rep
2025[Oct]; 15
(1
): 37855
PMID41162477
show ga
Evidence on the magnitude and duration of short- and long-term mortality
following osteoporotic fractures was mixed. We aimed to examine the short- and
long-term mortality risk after any and hip fractures. We conducted an "exposure
density sampling" dynamically matched cohort study based on 363,884 adults from
the UK Biobank, with a 1:4 (case: control) matching on age, sex, and frailty
status. A piecewise Cox proportional hazards model was used to estimate mortality
risk in different time periods from 30 days to 10 years after fractures. For any
fracture, the nested analysis cohort included 19,163 cases and 67,522 matched
controls, with a mean (SD) age of 58.3 (7.8) years and 59.5% of the cohort being
women. During follow-up, men had a higher post-fracture mortality rate than women
(15.85 vs. 8.58 per 1,000 person-years). After adjustment, mortality risk peaked
within the first 30 days following any fractures (HR?=?23.31, 95% CI,
17.08-31.83), gradually declining but remaining elevated for up to 10 years
(1.44, 1.08-1.91). For hip fracture, the analysis comprised 3,114 cases and
12,070 matched controls. A similar temporal pattern was observed, with the
highest mortality risk occurring within the first 30 days (23.67, 12.17-46.01),
followed by a gradual attenuation, though the high risk persisted for up to 10
years (2.15, 1.15-4.00). The above associations were consistently observed across
various characteristics of the participants. This study underscores the
significant association between fracture incidence and both short- and long-term
mortality, highlighting the potential value in comprehensive fracture management
strategies - from prevention to long-term care - though future research is needed
to establish causality and evaluate effective interventions.
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