Excess mortality following a first and subsequent osteoporotic fracture: a Danish nationwide register-based cohort study on the mediating effects of comorbidities.

Autor:	Christensen ER; OPEN - Open Patient data Explorative Network, Odense University Hospital, Odense, Denmark emilie.rosenfeldt.christensen@rsyd.dk., Clausen A; OPEN - Open Patient data Explorative Network, Odense University Hospital, Odense, Denmark.; Research Unit OPEN, Department of Clinical Research, University of Southern Denmark, Odense, Denmark., Petersen TG; OPEN - Open Patient data Explorative Network, Odense University Hospital, Odense, Denmark.; Research Unit OPEN, Department of Clinical Research, University of Southern Denmark, Odense, Denmark., Skjødt MK; Department of Medicine, Holbæk Hospital, Holbæk, Region Zealand, Denmark.; Department of Medicine, Gentofte Hospital, Hellerup, Copenhagen, Denmark., Abrahamsen B; Research Unit OPEN, Department of Clinical Research, University of Southern Denmark, Odense, Denmark.; Department of Medicine, Holbæk Hospital, Holbæk, Region Zealand, Denmark., Möller S; Research Unit OPEN, Department of Clinical Research, University of Southern Denmark, Odense, Denmark., Rubin KH; Research Unit OPEN, Department of Clinical Research, University of Southern Denmark, Odense, Denmark.
Jazyk:	angličtina
Zdroj:	RMD open [RMD Open] 2023 Nov 29; Vol. 9 (4). Date of Electronic Publication: 2023 Nov 29.
DOI:	10.1136/rmdopen-2023-003524
Abstrakt:	Objectives: This study aimed to examine the risk of mortality following incident and subsequent osteoporotic fractures, the effect of different fracture type combinations, and the mediating role of postfracture morbidity in a Danish population. Methods: We used the National Patient Registry to identify patients ≥60 years with incident major osteoporotic fracture of the hip, vertebrae, wrist or humerus between 2013 and 2018, and controls matched 1:10 on age and sex. Possible mediators were identified using International Classification of Diseases, 10th Revision codes registered in the 6 months following index fracture. HRs were estimated using Cox regression analyses with 95% CIs. The effect of possible mediators was estimated using mediation analyses. Results: The study included 106 303 patients and 1 062 988 controls. Mortality following index fracture was highest in the month following hip fractures (HR 10.98 (95% CI 10.23 to 11.79) in women and HR 16.40 (95% CI 15.00 to 17.93) in men). Subsequent hip fractures resulted in the highest HRs for all fracture type combinations. In women, the highest HR was observed in patients with index wrist/subsequent hip fractures (HR 2.43 (95% CI 2.12 to 2.78)). In men, the highest HR was observed in patients with index humerus/subsequent hip fractures (HR 2.69 (95% CI 2.04 to 3.54)). Pneumonia mediated the largest proportion of mortality, but dehydration, urinary tract infection and sepsis were also important factors. Conclusions: The highest mortality risk was found in the month immediately following both index and subsequent fracture. The combination of index and subsequent fractures at different skeletal sites had a substantial impact on the risk of mortality. Postfracture morbidities were found mediate the association. Competing Interests: Competing interests: ERC, AC, TGP, SM and KHR declare no competing interests. BA reports institutional research grants and personal fees from UCB, institutional research grants and personal fees from Kyowa-Kirin, institutional research grants and personal fees from Pharmacosmos, speakers fees from Amgen and speakers fees from Gedeon-Richter. MKS reports an educational grant from UCB, institutional research grants from UCB/Amgen and Region Zealand Health Scientific Research Foundation and a personal speakers fee from UCB Nordic. (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
Databáze:	MEDLINE
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