Suffering a hip or spine fracture can significantly increase the odds of an early death in people aged 50 and over, according to a new study by Canadian researchers.
The findings, published today in the Canadian Medical Association Journal, have significant implications and highlight the importance of osteoporosis screening and fall-prevention strategies in at-risk populations.
"Very few people know the consequences and the prevalence of osteoporosis," said George Ioannidis, health research methodologist at McMaster University in Hamilton and lead author of the study. "Not only is osteoporosis a life-changing disease; it can lead to death."
In the study, researchers tracked a group of 7,753 Canadians over five years and found those who suffered hip or spine fractures were much more likely to die within the follow-up period compared with those without fractures.
Unlike other studies, which have shown women to be at great risk of dying after suffering a hip or spine fracture, the new research suggests the hazards may be more evenly distributed and even tipped toward men in some cases.
More than 23 per cent of men and women who suffered hip fractures died in the study's follow-up period, while 18 per cent of men and nearly 16 per cent of women who suffered spinal fractures died. Wrist, forearm and other fractures did not seem linked to a significantly increased risk, the study found.
Fractures can often result in a "progressive decline in health," the study says, which helps explain why even healthy people can succumb to death after a fracture. People with hip fractures, for instance, have limited mobility, lose some independence and experience a decline in muscle mass, which can lead to more complicated and deadly problems, Dr. Ioannidis said.
"It's a downward spiral of disability, and as a result you die eventually," he said.
Dr. Ioannidis said the findings should serve as a wake-up call to Canadians that osteoporosis, a disease marked by rapid bone loss that leads to heightened fracture risk, is more prevalent than most people may believe. Health Canada estimates that one in four women and one in eight men over 50 will develop osteoporosis.
The problem is that many people aren't aware they have osteoporosis until it's too late.
"It's basically silent until a fracture occurs, and then you're in deep trouble," Dr. Ioannidis said.
Although there are ways to prevent fractures among people with osteoporosis, those methods can only be applied to those who know they have the condition. Dr. Ioannidis said Canadians must be aware of the risk factors associated with osteoporosis and speak to their health professionals in order to take advantage of any medical treatment or fall-prevention techniques that may save them from a fracture that could have a devastating impact on their lives. While bone density scans can identify if a person has osteoporosis, there are other telling risk factors, he said.
For instance, if a person's mother suffered a hip fracture, there is a much higher likelihood that individual will have osteoporosis, he said. An individual who is very thin may also be at risk, he said.
While it's well-known that people with osteoporosis are more susceptible to fractures, this study differs from earlier research because it followed a randomly selected group of Canadians over a five-year period rather than focusing on a subset of patients, such as women who have been diagnosed with osteoporosis. It's an important distinction, Dr. Ioannidis said, because it allows for a better picture of what fracture and subsequent mortality risks may be among the entire population of people aged 50 and over.
Several major improvements must be made to help patients avoid life-threatening fractures, according to a commentary published with the study.
Health professionals have long known the chance of death increases after a patient suffers a hip or spine fracture, wrote Karim Khan and Maureen Ashe of the Centre for Hip Health and Mobility at Vancouver's Coastal Health Research Institute and the family practice department at the University of British Columbia.
Despite this, many patients don't receive crucial treatments, such as bone mineral density assessments, vitamin D or calcium supplements, which could improve their chances of surviving years after the event.
They added that people with dementia or other cognitive disorders are at much greater risk of falling, which means special attention should be paid to helping prevent those problems.
Carly Weeks