Secular changes in postfracture outcomes over 2 decades in Australia: A time-trend comparison of excess postfracture mortality in two birth controls over two decades

Abstract

Context: Hip fracture incidence has been declining and life expectancy improving. However, trends of postfracture outcomes are unknown. Objectives: The objective of the study was to compare the refracture risk and excess mortality after osteoporotic fracture between two birth cohorts, over 2 decades. Design: Prospective birth cohorts were followed up over 2 decades (1989-2004 and 2000-2014). Setting: The study was conducted in community-dwelling participants in Dubbo, Australia. Participants: Women and men aged 60-80 years, participating in Dubbo Osteoporosis Epidemiology Study 1 (DOES 1; born before 1930) and Dubbo Osteoporosis Epidemiology Study 2 (DOES 2; born after 1930) participated in the study. Main Outcome Measure: Age-standardized fracture and mortality over two time intervals: (1989- 2004 [DOES 1] and 2000-2014 [DOES 2]) were measured. Results: The DOES 2 cohort had higher body mass index and bone mineral density and lower initial fracture rate than DOES 1, but similar refracture rates [age-standardized refracture rates per 1000 person-years:women:53(95%confidence interval [CI]42-63)and51(95%CI41-60)andmen:53(95% CI 38-69) and 55 (95% CI 40-71) for DOES 2 and DOES 1, respectively). Absolute postfracture mortality rates declined inDOES2comparedwithDOES1, mirroring theimprovementin general-population life expectancy. However, when compared with period-specific general-population mortality, there was a similar 2.1- To 2.6-fold increased mortality risk after a fracture in both cohorts (age-adjusted standardized mortality ratio, women: 2.05 [95% CI 1.43-2.83] and 2.43 [95% CI 1.95-2.99] and men: 2.56 [95% CI 1.78-3.58] and 2.48 [95% CI 1.87-3.22] for DOES 2 and DOES 1, respectively). Conclusion: Over the 2 decades, despite the decline in the prevalence of fracture risk factors, general-population mortality, and initial fracture incidence, there was no improvement in postfracture outcomes. Refracture rates were similar and fracture-associated mortality was 2-fold higher than expected. These data indicate that thelowpostfracture treatment rates are still a major problem.