In an effort to separate out the effect of hip fractures from the underlying death risk associated with preexisting health problems, the researchers performed a more detailed analysis in women age 80 and up, a group that is generally sicker and more likely to die.
Hip fracture did not measurably increase the one-year odds of death in this age group as a whole, but it nearly tripled the odds among the subset of women who considered themselves to be in good or excellent health. The fact that hip fracture was linked to an increased risk of death only when illness was removed from the picture provides more evidence that fracture can be a cause of death, the researchers say.
Fractures appeared to be most dangerous in the youngest segment of study participants: For women 65 to 69, hip fracture quintupled the odds of death within one year. This was also the only age group in which the odds of death remained higher in the fracture group after the one-year mark.
The findings in these relatively young women should be a wake-up call to physicians and patients alike, says Silvina Levis, MD, director of the osteoporosis center at the University of Miami Miller School of Medicine.
“Many people assume that this increased mortality mostly applies to the very old,” says Levis, who was not involved in the study. “But having seen this result, I think younger women are the ones who should be very much aware and should talk to their doctors about ways of assessing risk.”
Women should have a bone-density test at age 65 (or younger if they have other osteoporosis risk factors), and those with low bone mass or osteoporosis may want to consider taking medications to reduce their risk of fractures, Levis says.
Dr. LeBlanc says it’s important for all postmenopausal women to get enough bone-strengthening calcium and vitamin D in their diet, avoid smoking and excessive alcohol intake, and assess their homes for hazards that could cause slips and falls. “Thinning of the bones is silent,” she says. “It doesn’t hurt, and if you’re not proactive you might not know you have it until you break something.”
These steps are especially important for a woman who has already had a fracture, Dr. LeBlanc adds, since she is at high risk for a second one.