Type of fracture, underlying health linked to poor outcomes in seniors

Oct. 10 (UPI) -- Specific pre-existing health conditions, and their combinations, in older people make it likelier they could die after breaking a bone -- a much greater risk than either the fracture or the illnesses alone, a large study suggests.

For example, the one-year "excess mortality" rate after hip fracture among men in the study's cancer group was 41%, more than double the 19.9% hip fracture mortality rate for similarly aged men in the group with generally only one or no health conditions.

They noted that the excess mortality of patients in the cancer cluster with hip fracture was approximately two- and six-fold greater than that of either hip fracture alone or belonging to the cancer cluster, respectively.

Diabetes in otherwise healthy people was not associated with an increased risk of death after fractures, but diabetes in combination with heart, vascular or kidney disease was, the team led by researchers from Australia and Denmark said.

They also found that study participants with underlying health conditions who had fractures closer to the body's center, such as in the hip, spine, upper arm or leg, had a higher mortality rate than what's expected for the general population of the same age, a news release said.

According to the researchers, the findings highlight the need to prevent fracture in high-risk patients and could change the way in which medical care is provided to older adults -- promoting a new way of thinking about patients with fractures that considers the site of the broken bone in light of specific underlying health conditions.

"This research highlights that there's an interaction between the fracture and a patient's cluster of health conditions -- their underlying health -- and that this could be a good way to identify at-risk people," Dr. Thach Tran, the study's corresponding author and research officer in the Skeletal Diseases Program at Garvan Institute of Medical Research in Sydney, Australia, said in the release.

The researchers anticipate the findings, published Monday in JAMA Network Open, could be used by clinicians to target older patients who may require more intensive medical care after breaking bones.

They said the research could promote a new way of thinking about older patients with fractures that considers the site of the broken bone in light of specific underlying health conditions.

The study included nearly 308,000-plus Danish people aged 50 or older: all individuals in Denmark born on or before Jan. 1,1951, who had an incident low-trauma fracture between Jan. 1, 2001, and Dec. 31, 2014, when the men were 72 years old and the women were 75 years old, on average.

Face, skull, finger or toe fractures and high-trauma fractures due to traffic accidents were excluded, the research paper said.

The participants were followed at least two years post-fracture; most follow-up ran 6 years, during which time 43% of men and 38.5% of women in the study died.

The researchers found chronic health conditions at the time of fracture were naturally clustered into five specific groups for men and four for women: most fell in a relatively healthier group with generally only one or no health conditions, comprising 60.5% of men and 66.5% of women.

In this group, the highest excess mortality was found in patients 1 year after hip fracture: 19.89% in men and 11.17% in women.

Almost one-quarter of the study's participants with fractures were grouped in the cardiovascular cluster, in which most men and women had three or more comorbidities. There was also a diabetic group and a cancer group, with an additional liver/inflammatory illness group for men only.

In one example of differences, the researchers said men with a forearm fracture in the diabetic cluster had one-year excess mortality of 3.21; in the cardiovascular cluster, 5.44%; in the hepatic and/or inflammatory cluster, 5.89%; and in the cancer cluster, 7.59%.

Overall, 43% of patients with fractures had at least two illnesses, or comorbidities.

The scientists took into account the severity of the study participants' chronic illnesses and their combinations: clusters distinguished individuals with advanced, complex or late-stage disease from those with earlier-stage disease.

They noted, for example, that many patients with a history of prior cancers were not in the cancer cluster, but this cluster included virtually all patients who showed evidence of advanced cancer. Other clusters were similarly sorted by severity of illness.

The researchers said it is not yet understood why there is a connection between multiple underlying health conditions, the type of fracture and poor outcomes.

But the interaction between bones and the immune system may be key, professor Jacqueline Center, the study's lead author and head of the Garvan Institute's clinical studies and epidemiology laboratory, said in the release.

"Bone is not inert. When you break a bone, you get increased bone turnover and associated inflammatory factors and I suspect that in underlying diseases, this process is not well controlled and a fracture may fuel underlying health issues," she said.

The scientists said further research is needed to determine whether the findings are applicable to other diseases, and are in fact universal. If so, they said, these clusters may become used as a predictive tool for clinicians.

The researchers said the study builds upon previous findings suggesting that a history of heart failure, chronic obstructive pulmonary disease, dementia or cancer is associated with added mortality risk after hip fracture.