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Abstract
Osteoporotic fractures are a major public health issue and reliable data are essential for effective health care planning. This thesis uses data from the Sax Institute’s 45 and Up Study, a prospective study of over 260,000 residents of New South Wales (NSW) in Australia, to examine the incidence, hospital bed-use and premature mortality related to osteoporotic fractures. The thesis especially examines non-hip non-vertebral (NHNV) fractures for which less reliable data are available.
This research has several major findings including documenting the incidence of different fracture types. Interestingly the results suggest the incidence of hip fracture may be lower than predicted in the 2012 Osteoporosis Australia Burden of Disease report. This has important implications for delivery of health care services. The hospital bed occupancy data demonstrate that NHNV fractures, account for over 50% of the total number of acute bed days for fractures. This impact of NHNV fractures has not previously been fully appreciated.
Furthermore, the mortality data demonstrate, for the first time at some sites, that most osteoporotic fractures are associated with increased premature mortality. The mortality risk was increased following all proximal NHNV fractures, namely pelvis, femur, humerus, clavicle, elbow, proximal tibia/fibula and distal forearm fractures. Importantly this thesis also demonstrates that, in men at least, ankle fractures are associated with increased premature mortality. Identifying increased mortality in NHNV fractures is the first necessary step prior to examining post-fracture care and possible improvement in survival.
The magnitude of premature mortality following fractures was larger than expected for some skeletal sites. Importantly, the mortality data also demonstrated the independent and additive role of fractures to comorbidities such that a woman with a humerus fracture and one comorbidity had a similar mortality as a woman with a hip fracture and no comorbidities. This has important implications for appropriate management of patients with perceived lower-risk fractures, as well as the higher profile hip fractures. Increasing poor health and frailty, as risk factors for fracture and mortality, is an area also justifying further research.
In conclusion, NHNV fractures have serious impacts on individuals and at the society level and warrant more attention.