Mortality outcomes after osteoporotic fractures in men and women.

BACKGROUND Underwriting the elderly will challenge the skills of the medical director. Factors not typically reflecting an increased mortality risk in younger applicants assume major importance in the elderly. This article demonstrates osteoporotic fractures in the elderly can be predictive of adverse mortality. MATERIALS AND METHODS In a 5-year prospective community study, all residents age 60 and over were screened for low-impact fractures, defined as those from a standing height or less. Two fracture groups were analyzed: proximal femur (hip) and combined vertebral and other major fractures. Those with predisposing underlying disease were excluded. Follow-up was nearly 100%. Age- and sex-specific mortality for expected and those with each fracture group were calculated. Through an abridged life table analysis technique, the authors were able to create a 25-year cumulative survival analysis. RESULTS There were more deaths among fracture patients in both groups than in the expected general population. Females with vertebral and other major fractures had a mortality ratio of 188% and excess death rate of 7. For hip fractures, values were 500% and 32. Males exhibited more adverse mortality, with a mortality ratio of 330% and excess death rate of 30 for vertebral and other major fractures and 540% and excess death rate of 57 for hip fractures. CONCLUSION Osteoporotic fractures are risk factors for increased mortality in both males and females age 60 and older. The fractures contribute directly to mortality but more importantly appear to be a marker for comorbid conditions.