Survival rates after hip or spine fracture worse than for many cancers

A new article in JBMR Plus indicates that patient survival rates after hip or other bone fractures can be very poor. While patients and their families may dismiss a fracture as a minor injury, survival rates can be lower than those for many types of cancer.

Scientists have gathered a body of evidence about mortality outcomes in patients over 50, but survival rates following bone fractures are not often included in the statistics available to patients or caregivers. The aim of this current real-world population-based study of close to 100,000 subjects was to show the post-fracture prognosis in people over 65 years by examining the overall survival by gender, age groups, and types of fractures, using the database of the Ontario, Canada public health care system.

In the entire fracture cohort over 65, less than a third of men and half of women survived five years after a hip fracture, with overall survival rates being marginally better following vertebral fracture. The oldest patients, those over 85, had the worst prognosis. Female patients tended to have better post-fracture survival than men, but had a significantly higher risk for getting a fracture in the first place.

The paper emphasizes that the greatest reduction in survival in both genders occurred within the initial month after a fracture, indicating a high relative impact of short-term factors. This suggests the most critical period for doctors to intervene to improve patient prognoses is immediately after a fracture.

The paper notes that the five-year survival rates after a diagnosis of different types of cancer relevant to older adults are as follows: 64% in patients 60 to 79 years with any type of cancer, 43% in those over 80 with any type of cancer, 94% in men of any age with prostate cancer, and 89% in women (any age) with breast cancer. Therefore, survival outcomes for fractures in older adults are comparable to or worse than those seen for patients afflicted by some common types of cancer.

"This large study of Canadians over 65 strongly demonstrates that survival most dramatically declined within one month after most types of fracture, with a five-year survival being similar to or worse than some common cancers," said the paper's lead author, Jacques Brown. "These observations highlight the urgency to change our attitude towards these patients and offer them secondary prevention interventions before hospital discharge, as recommended by the American Society for Bone and Mineral Research."