Fracture type, underlying health related to poor outcomes in older people

Fracture type, underlying health related to poor outcomes in older people
A new study suggests a connection between multiple underlying health conditions, the type of fracture, and poor outcomes.  Photo by Ashashyou/Wikimedia Commons

A new study suggests a connection between multiple underlying health conditions, the type of fracture, and poor outcomes. Photo by Ashashyou/Wikimedia Commons

Oct. 10 (UPI) — Specific pre-existing health conditions, and their combinations, in older people make them more likely to die after breaking a bone, a much higher risk than the fracture or disease alone, a large study suggests.

For example, the one-year “excess mortality” rate after a hip fracture among men in the cancer group in the study was 41%, more than double the hip fracture mortality rate of 19, 9% for age-matched men in the group who typically had only one or no disease. conditions.

They noted that the excess mortality of patients in the hip fracture cancer group was approximately two and six times greater than that of hip fracture alone or belonging to the cancer group, respectively.

Diabetes in otherwise healthy people was not associated with an increased risk of death after fractures, but diabetes in combination with heart, vascular or kidney disease was, the team led by researchers from Australia and Denmark said.

They also found that study participants with underlying health conditions who had fractures closer to the center of the body, such as in the hip, spine, upper arm, or leg, had a higher than expected death rate for the general population of the same age, a news release said.

According to the researchers, the findings highlight the need to prevent fractures in high-risk patients and could change the way healthcare is delivered to older adults, promoting a new way of thinking about fracture patients that considers the site of fracture. the injury. broken bone in light of specific underlying health conditions.

“This research highlights that there is 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 people at risk,” said Dr. Thach Tran, corresponding author of the study. and a research officer in the Skeletal Diseases Program at the Garvan Institute for Medical Research in Sydney, Australia, said in the statement.

The researchers anticipate that the findings, published Monday in JAMA Network Open, could be used by doctors to target older patients who may require more intensive medical care after breaking bones.

They said the research could promote a new way of thinking about older fracture patients that considers the site of the broken bone in light of specific underlying health conditions.

The study included almost 308,000 Danish people aged 50 and over: all people in Denmark born on or before January 1, 1951, who suffered an incident minor trauma fracture between January 1, 2001 and December 31 of 2014. when men were 72 years old and women 75 years old, on average.

Fractures of the face, skull, fingers or toes, and major trauma fractures due to traffic accidents were excluded, according to the research paper.

Participants were followed up for at least two years after the fracture; most of the follow-up lasted 6 years, during which time 43% of the men and 38.5% of the women in the study died.

The researchers found that chronic health conditions at the time of the fracture naturally clustered into five specific groups for men and four for women: most belonged to a relatively healthier group with generally only one or no health conditions, comprising 60.5% of men and 66.5% of women.

In this group, the highest excess mortality was found in patients 1 year after the hip fracture: 19.89% in men and 11.17% in women.

Nearly a quarter of the study participants with fractures fell into the cardiovascular group, in which most men and women had three or more comorbidities. There was also a diabetic group and a cancer group, with an additional liver/inflammatory disease group for men only.

In one example of differences, the researchers said that men with a forearm fracture in the diabetic group had an excess 1-year mortality of 3.21; in the cardiovascular cluster, 5.44%; in the hepatic and/or inflammatory cluster, 5.89%; and in the cancer cluster, 7.59%.

Overall, 43% of patients with fractures had at least two diseases or comorbidities.

The scientists took into account the severity of the study participants’ chronic illnesses and their combinations: the groups distinguished individuals with advanced, complex, or late-stage disease from those with earlier-stage disease.

They noted, for example, that many patients with a history of previous cancers were not in the cancer group, but this group included virtually all patients who showed evidence of advanced cancer. Other groups were similarly ranked according to disease severity.

The researchers said it is not yet understood why there is a connection between multiple underlying health conditions, the type of fracture and poor outcomes.

But the interaction between the bones and the immune system may be key, Professor Jacqueline Center, the study’s lead author and director of the Garvan Institute’s clinical studies and epidemiology laboratory, said in the statement.

“Bone is not inert. When a bone breaks, it increases bone turnover and associated inflammatory factors, and I suspect that in underlying diseases, this process is not well controlled and a fracture can lead to underlying health problems,” he said.

The scientists said more research is needed to determine whether the findings are applicable to other diseases and, indeed, are universal. If so, they said, these clusters can be used as a predictive tool for clinicians.

The researchers said the study builds on previous findings suggesting that a history of heart failure, chronic obstructive pulmonary disease, dementia or cancer is associated with an increased risk of mortality after hip fracture.

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