Broken Bones: Risk of Death in the Elderly

By Dr Cary Presant MD

Fractures are a common part of life. For every 100 people, 3 to 4 fractures occur annually. Over a lifetime, 38.2% of people will have a fracture.

While everyone is aware of fractures associated with high trauma circumstances (automobile accidents, accidents around the home, and social violence), more commonly fractures occur with increasing age. The cause of this is osteoporosis, which increases with age, and fractures are usually associated with very little trauma. Often, the patient has a very simple fall or a simple twist, and the bone weakened by osteoporosis fractures. People know bones heal when a cast is applied, or the bone is fixed by an orthopedic surgeon using screws or plates, but most people are unaware of how dangerous fractures can be, especially in the elderly.

In a recent study, Dr. Dana Bliuc of St. Vincent’s Hospital in Sydney, Australia and co-workers (JAMA, Volume 301, page 513, 2009) studied an entire city in Australia to determine the consequences of a fracture in people over the age of 60. These physicians studied the city Dubbo, which is 400 kilometers northwest of Sydney. The population was 32,000 of which over 4,000 were over 60 years of age. These physicians looked at all fractures which occurred between 1989 and 2007, and analyzed the survival of these patients compared to individuals over 60 who had not sustained a fracture.

The results were scary. If an individual had a hip fracture, the death rate over the next 5 years was increased by 143%. With a spinal fracture, the death rate was increased by 182%. Although minor fractures did not increase the mortality rate for people under 75 years of age, the death rate was increased by 82% if the patient was male and over 75, and by 37% if the patient was female and over 75.

Factors that were found to most dramatically increase the risk of death were age, muscle weakness, a history of smoking, instability of walking, and reduced physical activity. Surprisingly, other underlying health problems or diseases were not found to be associated with a higher death rate.

What might have caused the increased rate of death? Mortality might have been due to increased blood clots in the veins or in the lungs, stress-producing heart attacks, infections, increased debility causing malnutrition, and/or stroke.

There are many lessons of this study for each of us. For ourselves and our family, we should be carefully monitoring bone density by use of appropriate simple x-ray tests. These tests can determine when a person develops osteopenia, a low bone density not nearly as severe as osteoporosis, and appropriate medical steps can be taken to prevent the higher risk osteoporosis. In addition, people should be asking their physician to monitor their vitamin D levels to determine if they require extra vitamin D to protect their bones against the development of osteoporosis. Since osteoporosis occurs more commonly in individuals who are sedentary, maintaining a good exercise program is also important.

In individuals over 60 years of age who have osteoporosis, the risk of fracture is very high. Therefore, appropriate measures should be taken around homes to reduce hazardous conditions. People at risk should avoid activities which can be associated with higher fracture rates. At appointments with the doctor remember to ask whether any medications can cause osteoporosis or risk of fracture.