Life Loss According to Age at Fracture Occurrence: A Nationwide Cohort Study

초록

Fractures related to osteoporosis significantly impact mortality and morbidity among the elderly, presenting sustained consequences for life expectancy. This retrospective cohort study, conducted in South Korea, included patients aged 50 and above who sustained hip fractures between 2010 and 2018. A total of 41,164 patients were studied after excluding those younger than 50 or with prior osteoporotic fractures or specific genetic conditions like Paget’s disease or Osteogenesis Imperfecta. A control group of 73,428 individuals, matched by age and sex on a 1:2 ratio from a larger pool of 1,286,894 patients, provided comparative data. The analysis focused on mortality rates starting one-year post-fracture to isolate the long-term eects from immediate post-fracture mortality. The average age was slightly higher in the fracture group (75.34 vs. 74.59 years), which also exhibited dierent socioeconomic backgrounds and health behaviors. Notably, the fracture group had higher comorbidity rates, including diabetes and hypertension, and a significantly higher utilization of osteoporosis medications (8.1% vs. 4.6%). Mortality analysis revealed that mortality risks were consistently higher in the fracture group across all age categories. Further adjustments were made for age, the Charlson Comorbidity Index (CCI), and osteoporosis medication usage to refine the adjusted hazard ratio (aHR). Specifically, men under 60 exhibited an aHR of 4.5 for mortality with a relative mean survival time (RMST) loss of 1.45 years. In contrast, for those over 80, the aHR decreased to 1.8, but the RMST loss increased to 2.06 years. Women showed a similar trend, with those under 60 facing an aHR of 6.1 and an RMST loss of 0.78 years, and those over 80 experiencing an aHR of 1.6 with an RMST of 1.83 years. This pattern of decreasing HRs with increasing RMST was consistent across both genders and all age groups, suggesting that while the immediate risk of death decreases with age, the overall impact on life expectancy grows. Other osteoporosis-related fractures also followed a similar mortality pattern but were less pronounced compared to hip fractures. These results highlight the substantial influence of hip fractures on long-term mortality, particularly among younger seniors. They stress the importance of comprehensive preventive measures, including osteoporosis management and lifestyle changes, to reduce fracture risks and improve elderly care.