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A Look Into How the "Blue Zone" Lifestyle May Affect Patients' Lives Before and After Hip Fracture: A
David E Ruckle1, Alden Dahan, Jose Jesurajan
1From the Department of Orthopedic Surgery, Loma Linda University Health, Loma Linda, CA (Ruckle, Jesurajan, Nayak, Rice, Wongworawat, and Rajfer), the Department of Anesthesiology, University of California San Diego, San Diego, CA (Dahan), Department of Orthopedic Surgery, University of Alabama Birmingham Medicine, Birmingham, Alabama (Johnson).
Insights
Blue zone residents experience delayed hip fractures by 12 years due to lifestyle factors. This population also shows significantly lower postoperative mortality rates, highlighting the benefits of a blue zone lifestyle on longevity and health outcomes.
Area of Science:
- Gerontology
- Public Health
- Orthopedics
Background:
- Hip fractures are a significant cause of mortality, with up to 30% one-year mortality.
- Blue zones are regions with exceptionally high longevity and centenarian populations.
- The Seventh-day Adventist lifestyle in Loma Linda, California, is a contributing factor to its blue zone status.
Purpose of the Study:
- To test the hypothesis that blue zone residents experience delayed, frailty-driven hip fractures.
- To investigate if blue zone patients have increased longevity post-hip fracture compared to non-blue zone controls.
Main Methods:
- A retrospective review of 1,032 hip fracture patients from January 2010 to August 2020.
- Patients were categorized into blue zone and non-blue zone cohorts.
- Mortality data were assessed via death registries; propensity score matching was used for analysis.
Main Results:
- Blue zone patients sustained hip fractures 12 years later in life (83.2 vs. 71.1 years).
- Postoperative mortality was lower in the blue zone cohort at 1 year (12% vs. 24%) and 2 years (20% vs. 33%).
- Blue zone patients had higher rates of hypertension and Seventh-day Adventist affiliation, and lower alcohol consumption.
Conclusions:
- The blue zone lifestyle delays the onset of frailty and osteoporotic hip fractures by approximately 12 years.
- Living in a blue zone is associated with markedly lower postoperative mortality following hip fracture.
Introduction:
Hip fractures are life-changing injuries with associated one-year mortality up to 30%. Five locations in the world have been termed "blue zones," where the longevity of the population is markedly higher than that of surrounding areas and there are 10 times more centenarians. The United States has one blue zone (Loma Linda, California), which is believed to be because of the lifestyle of the Seventh-day Adventist population living there. We hypothesized that patients from the blue zone experience low-energy, frailty-driven, osteoporotic hip fractures later in life and an increased postinjury longevity relative to non-blue zone control subjects.
Methods:
A review of patients treated for hip fracture between January 2010 and August 2020 from a single institution was conducted. Demographic data were collected, and the end point of mortality was assessed using death registry information, queried in April 2024. Groups were divided into blue zone and non-blue zone. Statistical analysis was conducted with P < 0.05 considered significant.
Results:
Complete data were available for 1,032 patients. The blue zone cohort sustained low-energy hip fractures 12 years later in life (83.2 versus 71.1, P < 0.01). Propensity score matching was used to account for this difference. After propensity score matching, age, body mass index, American Society of Anesthesiologists score, surgery performed, sex, mechanism, ethnicity, diabetes, chronic obstructive pulmonary disease, CHF, chronic kidney disease grade, dementia, surgical time, and drug/tobacco/marijuana use were similar between groups. Blue zone patients had lower mortality at both 1 and 2 years postoperatively (12% versus 24%, P = 0.03 and 20% versus 33%, P = 0.03, respectively), had more hypertension (76% versus 62%, P = 0.03), reported lower alcohol use (7% versus 20%, P < 0.01), and included more Seventh-day Adventists (64% versus 15%, P < 0.01).
Conclusion:
The blue zone lifestyle affected the onset of frailty and delayed osteoporotic hip fracture by 12 years in this propensity-matched cohort study. Postoperative mortality was also markedly lower in the blue zone cohort.
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