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Published on: August 17, 2017
All-cause mortality risk in older patients with femoral neck fracture
Xin-Ping Li1, Ping Zhang1, Shi-Wen Zhu2
1Department of Geriatrics, Beijing Jishuitan Hospital, 100035, Beijing, China.
Insights
Older male patients with femoral neck fracture and multiple comorbidities face higher mortality risks. Unlike intertrochanteric fractures, zoledronic acid did not reduce mortality in this group.
Area of Science:
- Orthopedics
- Geriatrics
- Public Health
Background:
- Hip fractures have high mortality rates, with variations between fracture types.
- Previous studies identified risk factors for intertrochanteric fractures, but not specifically for femoral neck fractures.
Purpose of the Study:
- To identify risk factors for all-cause mortality in elderly patients with femoral neck fractures.
Main Methods:
- A prospective cohort study of 307 elderly patients with femoral neck fractures.
- Analysis included general characteristics, bone mineral density, and post-operative anti-osteoporosis treatment.
- Kaplan-Meier curves and Cox proportional hazards models were used to assess mortality risk factors.
Main Results:
- Deceased patients were predominantly male, older (mean age 84.8 years), and had more comorbidities than survivors.
- Factors like fracture history, BMI, femoral neck T-score, hemoglobin, and vitamin D levels did not significantly differ between groups.
- Unlike intertrochanteric fractures, zoledronic acid treatment did not reduce all-cause mortality in femoral neck fracture patients.
Conclusions:
- Male sex, advanced age, and a high number of comorbidities are significant risk factors for mortality in Chinese patients with femoral neck fractures.
- Physicians should closely monitor these patient subgroups for improved outcomes.
Introduction:
The mortality rate after hip fracture is high. However, the 1-year mortality rate after femoral intertrochanteric fracture and femoral neck fracture differs (Gibson-Smith D, Klop C, Elders PJ, Welsing PM, van Schoor N, Leufkens HG, et al., Osteoporos Int 25:2555-2563, 2014), although both are types of hip fracture. A previous real-world single-center prospective cohort study showed that older age and high Charlson comorbidity index score were risk factors for femoral intertrochanteric fracture. Additionally, therapy with zoledronic acid 5 mg (Aclasta) was a protective factor (Li XP, Zhang P, Zhu SW, Yang MH, Wu XB, Jiang XY, J Orthop Surg Res. 16:727, 2021). We wished to determine the risk factors for all-cause mortality in femoral neck fracture patients.
Aim:
To identify the risk factors for postoperative all-cause mortality in aged patients with femoral neck fracture.
Materials And Methods:
We enrolled 307 aged patients with femoral neck fracture; 38 were lost to follow-up after 2-3 years. The patients' general characteristics, bone mineral density, and anti-osteoporosis treatment after operation were recorded as potential risk factors. Kaplan-Meier curves and multivariate Cox proportional hazards models were constructed to analyze the influence of each factor on all-cause mortality.
Results:
This was a real-world single-center prospective cohort study showing that (1) most of the patients who died were male, older (mean age of the patients who died: 84.8 years vs. 77.9 years for survivors), and had more comorbidities compared with surviving patients. Previous fracture history, body mass index, femoral neck T score, hemoglobin and 25-hydroxy vitamin D levels did not differ significantly between patients who died vs. survived. (2) Differing from patients with intertrochanteric fractures, older patients with femoral neck fracture experienced no reduction in all-cause mortality with treatment with zoledronic acid.
Conclusion:
In Chinese patients with femoral neck fracture, physicians should pay careful attention to male patients, older patients, and those with high numbers of comorbidities.
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