Patrick Haentjens, MD, PhD; Jay Magaziner, PhD; Cathleen S. Colón-Emeric, MD; Dirk Vanderschueren, MD, PhD; Koen Milisen, RN, PhD; Brigitte Velkeniers, MD, PhD; Steven Boonen, MD, PhD
Acknowledgment: The authors thank Dr. Geert Verbeke, head of the Interuniversity Institute for Biostatistics and Statistical Bioinformatics, Katholieke Universiteit Leuven and Universiteit Hasselt for his support during the final revision process of our manuscript.
Grant Support: By the Fund for Scientific Research (G.0488.08); Leuven University; National Institutes of Health (R01 AG06322, R01 HD0073, R37 AG09901, and P60 AG12583); the Paul B. Beeson Award (K23 AG024787); and the Willy Gepts Foundation, Universitair Ziekenhuis Brussel.
Potential Conflicts of Interest: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M09-0450.
Reproducible Research Statement:Study protocol and data set: Not available. Statistical code: Available from Dr. Haentjens (e-mail, firstname.lastname@example.org).
Requests for Single Reprints: Patrick Haentjens, MD, PhD, Centre for Outcomes Research and Laboratory for Experimental Surgery, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Laarbeeklaan 101, B-1090 Brussels, Belgium; e-mail, email@example.com.
Current Author Addresses: Dr. Haentjens: Center for Outcomes Research, Laboratory for Experimental Surgery, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Laarbeeklaan 101, 1090 Brussel, Belgium.
Dr. Magaziner: Department of Epidemiology and Preventive Medicine, School of Medicine, University of Maryland, Suite 200 Howard Hall, 660 West Redwood Street, Baltimore, MD 21201.
Dr. Colón-Emeric: Durham Veterans Affairs Geriatric Research Education and Clinical Center, 508 Fulton Street, Geriatric Research Education and Clinical Center 182, Durham, NC 27705.
Dr. Vanderschueren: Department of Andrology and Endocrinology, Universitair Ziekenhuis Leuven, Campus Gasthuisberg, Herestraat 49, B-3000 Leuven, Belgium.
Dr. Milisen: Centre for Health Services and Nursing Research, Universitair Ziekenhuis Leuven, Campus Gasthuisberg, Herestraat 49, B-3000 Leuven, Belgium.
Dr. Velkeniers: Departments of Endocrinology and General Internal Medicine, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Laarbeeklaan 101, 1090 Brussel, Belgium.
Dr. Boonen: Leuven University Division of Geriatric Medicine, Universitair Ziekenhuis Leuven, Campus Gasthuisberg, Herestraat 49, B-3000 Leuven, Belgium.
Author Contributions: Conception and design: P. Haentjens, S. Boonen.
Analysis of the data: P. Haentjens.
Interpretation of the data: P. Haentjens, S. Boonen, J. Magaziner, C.S. Colón-Emeric.
Drafting of the article: P. Haentjens, B. Velkeniers, S. Boonen.
Critical revision of the article for important intellectual content: P. Haentjens, J. Magaziner, C.S. Colón-Emeric, D. Vanderschueren, K. Milisen, B. Velkeniers, S. Boonen.
Final approval of the article: P. Haentjens, J. Magaziner, C.S. Colón-Emeric, D. Vanderschueren, K. Milisen, B. Velkeniers, S. Boonen.
Haentjens P., Magaziner J., Colón-Emeric C., Vanderschueren D., Milisen K., Velkeniers B., Boonen S.; Meta-analysis: Excess Mortality After Hip Fracture Among Older Women and Men. Ann Intern Med. 2010;152:380-390. doi: 10.7326/0003-4819-152-6-201003160-00008
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Published: Ann Intern Med. 2010;152(6):380-390.
Although an increased risk for death after hip fracture is well established, whether this excess mortality persists over time is unclear.
To determine the magnitude and duration of excess mortality after hip fracture in older men and women.
Electronic search of MEDLINE and EMBASE for English and non-English articles from 1957 to May 2009 and manual search of article references.
Prospective cohort studies were selected by 2 independent reviewers. The studies had to assess mortality in women (22 cohorts) or men (17 cohorts) aged 50 years or older with hip fracture, carry out a life-table analysis, and display the survival curves of the hip fracture group and age- and sex-matched control groups.
Survival curve data and items relevant to study validity and generalizability were independently extracted by 2 reviewers.
Time-to-event meta-analyses showed that the relative hazard for all-cause mortality in the first 3 months after hip fracture was 5.75 (95% CI, 4.94 to 6.67) in women and 7.95 (CI, 6.13 to 10.30) in men. Relative hazards decreased substantially over time but did not return to rates seen in age- and sex-matched control groups. Through use of life-table methods, investigators estimated that white women having a hip fracture at age 80 years have excess annual mortality compared with white women of the same age without a fracture of 8%, 11%, 18%, and 22% at 1, 2, 5, and 10 years after injury, respectively. Men with a hip fracture at age 80 years have excess annual mortality of 18%, 22%, 26%, and 20% at 1, 2, 5, and 10 years after injury, respectively.
Cohort studies varied, sometimes markedly, in size, duration of observation, selection of control populations, ascertainment of death, and adjustment for comorbid conditions. Only published data that displayed findings with survival curves were examined. Publication bias was possible.
Older adults have a 5- to 8-fold increased risk for all-cause mortality during the first 3 months after hip fracture. Excess annual mortality persists over time for both women and men, but at any given age, excess annual mortality after hip fracture is higher in men than in women.
Fund for Scientific Research and Willy Gepts Foundation, Universitair Ziekenhuis Brussel.
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