Incidence and mortality of fractures by frailty level over 80 years of age: cohort study using UK electronic health records.

Autor:	Ravindrarajah R; Department of Primary Care and Public Health Sciences, King's College London, London, UK., Hazra NC; Department of Primary Care and Public Health Sciences, King's College London, London, UK., Charlton J; Department of Primary Care and Public Health Sciences, King's College London, London, UK., Jackson SHD; National Institute for Health Research Biomedical Research Centre at Guy's and St Thomas' National Health Service Foundation Trust, Kings' College London, London, UK., Dregan A; Department of Primary Care and Public Health Sciences, King's College London, London, UK.; National Institute for Health Research Biomedical Research Centre at Guy's and St Thomas' National Health Service Foundation Trust, Kings' College London, London, UK.; Department of Clinical Gerontology, King's College London, London, UK., Gulliford MC; Department of Primary Care and Public Health Sciences, King's College London, London, UK.; National Institute for Health Research Biomedical Research Centre at Guy's and St Thomas' National Health Service Foundation Trust, Kings' College London, London, UK.; Department of Clinical Gerontology, King's College London, London, UK.
Jazyk:	angličtina
Zdroj:	BMJ open [BMJ Open] 2018 Jan 21; Vol. 8 (1), pp. e018836. Date of Electronic Publication: 2018 Jan 21.
DOI:	10.1136/bmjopen-2017-018836
Abstrakt:	Objective: This study aimed to estimate the association of frailty with incidence and mortality of fractures at different sites in people aged over 80 years. Design: Cohort study. Setting: UK family practices from 2001 to 2014. Participants: 265 195 registered participants aged 80 years and older. Measurements: Frailty status classified into 'fit', 'mild', 'moderate' and 'severe' frailty. Fractures, classified into non-fragility and fragility, including fractures of femur, pelvis, shoulder and upper arm, and forearm/wrist. Incidence of fracture, and mortality within 90 days and 1 year, were estimated. Results: There were 28 643 fractures including: non-fragility fractures, 9101; femur, 12 501; pelvis, 2172; shoulder and upper arm, 4965; and forearm/wrist, 6315. The incidence of each fracture type was higher in women and increased with frailty category (femur, severe frailty compared with 'fit', incidence rate ratio (IRR) 2.4, 95% CI 2.3 to 2.6). Fractures of the femur (95-99 years compared with 80-84 years, IRR 2.7, 95% CI 2.6 to 2.9) and pelvis (IRR 2.9, 95% CI 2.5 to 3.3) were strongly associated with age but non-fragility and forearm fractures were not. Mortality within 90 days was greatest for femur fracture (adjusted HR, compared with forearm fracture 4.3, 95% CI 3.7 to 5.1). Mortality was higher in men and increased with age (HR 5.3, 95% CI 4.3 to 6.5 in those over 100 years compared with 80-84 years) but was less strongly associated with frailty category. Similar associations with fractures were seen at 1-year mortality. Conclusions: The incidence of fractures at all sites was higher in women and strongly associated with advancing frailty status, while the risk of mortality after a fracture was greater in men and was associated with age rather than frailty category. Competing Interests: Competing interests: None declared. (© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.)
Databáze:	MEDLINE
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