Researchers studying fractures in older adults found a higher death rate when those fractures were closer to the center of the body and also when patients had particular underlying health issues.
This information could help doctors because it highlights the patients who may require more intensive medical care after a fracture.
“This is an important study that could really change the way in which we provide medical treatment to older adults,” said lead study author Jacqueline Center, head of the Clinical Studies and Epidemiology Lab for the Garvan Institute of Medical Research in Australia. “It can potentially be a new way of thinking about how we view people with fractures, considering the site of fracture in light of their specific underlying health conditions.”
The researchers studied the issue in more than 300,000 Danish people aged 50 and up who had sustained a fracture.
People who had a fracture in a more central area — such as a hip, vertebrae or upper arm bones — had a higher death rate compared to those whose fracture was further out, such as in the hands or forearms.
The risk was higher still for people with fractures who also had multiple or complex health conditions, particularly in those with certain clusters of conditions.
In their research, the team found that chronic health conditions at the time of the fracture were naturally clustered into five specific groups for men and four for women. These were a relatively healthier group with one or no health conditions; a cardiovascular group; a diabetic group; and a cancer group. Men also had a liver/inflammatory group.
“It is not good enough to count other illnesses," said Robert Blank, a visiting scientist at Garvan. “Their severity and their combinations must also be taken into account. Many patients with a history of prior cancers, for example, were not in what we call the cancer cluster, but the cancer cluster included virtually all those who had evidence of advanced cancer. The same kind of sorting by severity was observed in the other clusters as well.”
Specific findings included that the death rate following a hip fracture in men in the cancer cluster was 41% higher than in similarly aged men in the general community.
While diabetes itself in otherwise healthy people was not associated with an increased risk of death during the study, having diabetes in combination with heart, vascular or kidney disease was a risk.
“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,” study first author Dr. Thach Tran from Garvan, said in an institute news release.
“We can identify people who will likely fare poorly. Importantly, the findings from this research may be applicable to many disease settings in which sentinel events occur with preexisting health disorders,” Tran added.
Though it's not clear why this happens, it could be the interaction between bones and the immune system, Center said.
“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,” Center said.
The study authors said the next steps will be to determine if these clusters are evident in other diseases and can be used as a predictive tool for clinicians.
The findings were published online Oct. 10 in JAMA Network Open.
The U.S. Centers for Disease Control and Prevention has more on hip fractures in older adults.
SOURCE: Garvan Institute of Medical Research, news release, Oct. 10, 2022