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

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

J Clin Endocrinol Metab. 2016 Apr 26;:jc20161514

Authors: Bliuc D, Tran T, Alarkawi D, Nguyen TV, Eisman JA, Center JR

Abstract
CONTEXT: Hip fracture incidence has been declining and life expectancy improving. However, trends of post-fracture outcomes are unknown.
OBJECTIVES: To compare re-fracture risk and excess mortality following osteoporotic fracture between two birth cohorts, over two decades.
DESIGN: Prospective birth-cohorts followed over two decades (1989-2004 and 2000-2014) Setting: Community-dwelling participants in Dubbo, Australia.
PARTICIPANTS: Women and men aged 60-80, participating in DOES1 (born before 1930) and DOES2 (born after 1930).
MAIN OUTCOME MEASURE: Age-standardised fracture and mortality over two time intervals: 1989-2004 (DOES1) and 2000-2014 (DOES2).
RESULTS: DOES 2 cohort had higher BMI and BMD and lower initial fracture rate than DOES 1, but similar re-fracture rates [age-standardized re-fracture rates /1000 person-years: women: 53 (42-63) and 51 (95% CI, 41-60) and men: 53 (38-69) and 55 (40-71), for DOES 2 and DOES 1, respectively)]. Absolute post: fracture mortality rates declined in DOES 2 compared to DOES 1, mirroring the improvement in general-population life expectancy. However, when compared to period-specific general-population mortality, there was a similar 2.1-2.6 fold increased mortality risk post-fracture in both cohorts [age-adjusted SMR, women: 2.05 (1.43-2.83) and 2.43 (1.95-2.99) and men: 2.56 (1.78- 3.58) and 2.48 (1.87- 3.22), for DOES 2 and DOES 1, respectively].
CONCLUSION: Over the two decades, despite the decline in the prevalence of fracture risk factors, general-population mortality and initial fracture incidence, there was no improvement in post-fracture outcomes. Re-fracture rates were similar and fracture-associated mortality was 2-fold higher than expected. These data indicate that the low post-fracture treatment rates are still a major problem.

PMID: 27115062 [PubMed - as supplied by publisher]

from #MedicinebyAlexandrosSfakianakis via xlomafota13 on Inoreader http://ift.tt/26txI39
via IFTTT