title: Mortality risk associated with low-trauma osteoporotic fracture and subsequent fracture in men and women. Mortality and morbidity after hip fractures. Relation between fractures and mortality: results from the Canadian Multicentre Osteoporosis Study The economic cost of hip fractures in community-dwelling older adults: a prospective study. Effect of vertebral fractures on function, quality of life and hospitalisation the AGES-Reykjavik study. Risk of subsequent fracture after low-trauma fracture in men and women. Targeted intervention reduces refracture rates in patients with incident non-vertebral osteoporotic fractures: a 4-year prospective controlled study Osteoporosis prevalence and levels of treatment in primary care: the Australian BoneCare Study. Incidental vertebral fractures discovered with chest radiography in the emergency department: prevalence, recognition, and osteoporosis management in a cohort of elderly patients. A Controlled Trial To Increase Detection and Treatment of Osteoporosis in Older Patients with a Wrist Fracture Long-term cost and effect on quality of life of osteoporosis-related fractures in Sweden Pain and disability associated with new vertebral fractures and other spinal conditions. Incidence of subsequent hip fractures is significantly increased within the first month after distal radius fracture in patients older than 60 years Prediction of Mortality in Elderly Patients with Hip Fractures: A Two-Year Prospective Study of 1,944 Patients
abstract: CONTEXT There are few data on long-term mortality following  osteoporotic fracture and fewer following subsequent fracture . OBJECTIVES To examine long-term mortality risk in women and men following all osteoporotic fractures  and to assess the association of subsequent fracture with that risk . DESIGN , SETTING , AND PARTICIPANTS Prospect i ve cohort from the Dubbo Osteoporosis Epidemiology Study of community-dwelling women and men aged 60 years and older from Dubbo , Australia , who sustained a fracture between April 1989 and May 2007 . MAIN OUTCOME MEASURES Age- and sex-specific st and ardized mortality ratios ( SMRs ) compared with the overall Dubbo population for hip , vertebral , major , and minor fractures . RESULTS In women , there were 952 low-trauma fractures followed by 461 deaths , and in men , 343 fractures were followed by 197 deaths .  Age-adjusted SMRs were increased following hip fractures ( SMRs , 2.43 [ 95 % confidence interval [ CI ] , 2.02 - 2.93 ] and 3.51 [ 95 % CI , 2.65 - 4.66 ] ) , vertebral fractures ( SMRs , 1.82 [ 95 % CI , 1.52 - 2.17 ] and 2.12 [ 95 % CI , 1.66 - 2.72 ] ) , major fractures ( SMRs , 1.65 [ 95 % CI , 1.31 - 2.08 ] and 1.70 [ 95 % CI , 1.23 - 2.36 ] ) , and minor fractures ( SMRs , 1.42 [ 95 % CI , 1.19 - 1.70 ] and 1.33 [ 95 % CI , 0.99 - 1.80 ] ) for both women and men , respectively . Mortality was increased for all ages for all fractures except minor fractures for which increased mortality was only apparent for those older than 75 years . Increased mortality risk persisted for 5 years for all fractures and up to 10 years for hip fractures . Increases in absolute mortality that were above expected , for 5 years after fracture , ranged from 1.3 to 13.2 per 100 person-years in women and from 2.7 to 22.3 per 100 person-years in men , depending on fracture type . Subsequent fracture was associated with an increased mortality hazard ratio of 1.91 ( 95 % CI , 1.54 - 2.37 ) in women and 2.99 ( 95 % CI , 2.11 - 4.24 ) in men . Mortality risk following a subsequent fracture then declined but beyond 5 years still remained higher than in the general population ( SMR , 1.41 [ 95 % CI , 1.01 - 1.97 ] and SMR , 1.78 [ 95 % CI , 0.96 - 3.31 ] for women and men , respectively ) . Predictors of mortality after any fragility fracture for both men and women included age , quadriceps weakness , and subsequent fracture but not comorbidities . Low bone mineral density , having smoked , and sway were also predictors for women and less physical activity for men . CONCLUSIONS In a sample of older women and men , all low-trauma fractures were associated with increased mortality risk for 5 to 10 years . Subsequent fracture was associated with increased mortality risk for an additional 5 years OBJECTIVE --To study the mortality and morbidity associated with proximal femoral fractures with reference to fracture type ( intracapsular and extracapsular )  . DESIGN --Consecutive prospect i ve study with 12 month follow ups . SETTING --Two British trauma receiving centres . PATIENTS --1000 consecutive acute proximal femoral fractures ( fractured necks of femur ) in 972 patients . RESULTS --Significantly higher mortality at one year was seen in patients with extracapsular fractures ( 188/490 ; 38 % ) than in those with intracapsular fractures ( 147/510 ; 29 % ; p < 0.01 ) . Greater morbidity was experienced during the study period by patients with extracapsular fractures , who were less mobile and less independent at the time of their injury . CONCLUSIONS --The rise in average age of presentation with proximal femoral fracture is associated with a persistently high mortality ( 33 % ) and morbidity , greater in patients with an extracapsular fracture . Comparison with other studies , principally from outside Britain , is difficult , but despite advancing st and ards of care the mortality and morbidity of femoral neck fractures remains high , placing an ever increasing burden on the health service Background : Fractures have largely been assessed by their impact on quality of life or health care costs . We conducted this study to evaluate the relation between fractures and mortality . Methods : A total of 7753 r and omly selected people ( 2187 men and 5566 women ) aged 50 years and older from across Canada participated in a 5-year observational cohort study  . Incident fractures were identified on the basis of vali date d self-report and were classified by type ( vertebral , pelvic , forearm or wrist , rib , hip and “ other ” ) . We subdivided fracture groups by the year in which the fracture occurred during follow-up ; those occurring in the fourth and fifth years were grouped together . We examined the relation between the time of the incident fracture and death . Results : Compared with participants who had no fracture during follow-up , those who had a vertebral fracture in the second year were at increased risk of death ( adjusted hazard ratio [ HR ] 2.7 , 95 % confidence interval [ CI ] 1.1–6.6 ) ; also at risk were those who had a hip fracture during the first year ( adjusted HR 3.2 , 95 % CI 1.4–7.4 ) . Among women , the risk of death was increased for those with a vertebral fracture during the first year ( adjusted HR 3.7 , 95 % CI 1.1–12.8 ) or the second year of follow-up ( adjusted HR 3.2 , 95 % CI 1.2–8.1 ) . The risk of death was also increased among women with hip fracture during the first year of follow-up ( adjusted HR 3.0 , 95 % CI 1.0–8.7 ) . Interpretation : Vertebral and hip fractures are associated with an increased risk of death . Interventions that reduce the incidence of these fractures need to be implemented to improve survival OBJECTIVES To evaluate the incremental cost in the year after hip fracture . DESIGN Prospect i ve cohort study . SETTING Baltimore , Maryl and . PARTICIPANTS 759 community dwelling older patients who sustained a hip fracture and participated in the Baltimore Hip Fracture Study . MEASUREMENTS Re source use for direct medical care , formal nonmedical care , and informal care in the 6 months before and the year after fracture was estimated from interviews with patients or proxy respondents .  Costs in 1993 dollars were estimated by multiplying re sources times national unit cost estimates . RESULTS The annualized costs in the year before the fracture ranged between $ 18,523 and $ 20,928 . The costs in the year after the fracture equaled $ 37,250 . The incremental costs in the year after the fracture , compared with the costs in the year before the fracture , ranged between $ 16,322 and $ 18,727 . The largest cost differences were attributable to hospitalizations , nursing home stays , and rehabilitation services . CONCLUSIONS Because we compared the costs after a fracture with costs before , our estimates of the incremental cost of a hip fracture are lower than others in the literature . These results , obtained from interviews with patients enrolled in a cohort study , or their proxies , provide the best data available to date on the economic cost of hip fractures among community-dwelling older persons BACKGROUND underst and ing the determinants of health burden after a fracture in ageing population s is important . OBJECTIVE assess the effect of clinical vertebral and other osteoporotic fractures on function and the subsequent risk of hospitalisation . DESIGN individuals from the prospect i ve population -based cohort study Age , Gene/Environment Susceptibility (AGES)-Reykjavik study were examined between 2002 and 2006 and followed up for 5.4 years . SUBJECTS a total of 5,764 individuals , 57.7 % women , born 1907 - 35 , mean age 77 . METHOD four groups with a verified fracture status were used ; vertebral fractures , other osteoporotic fractures excluding vertebral , non-osteoporotic fractures and not-fractured were compared and analysed for the effect on mobility , strength , QoL , ADL , co-morbidity and hospitalisation . RESULTS worst performance on functional tests was in the vertebral fracture group for women ( P < 0.0001 ) and the other osteoporotic fractures group for men ( P < 0.05 ) . Both vertebral and other osteoporotic fractures , showed an increased risk of hospitalisation , HR = 1.4 ( 95 % CI : 1.3 - 1.7 ) and 1.2 ( 95 % CI : 1.1 - 1.2 ) respectively ( P < 0.0001 ) . Individuals with vertebral fractures had 50 % ( P < 0.0001 ) longer hospitalisation than not-fractured and 33 % ( P < 0.002 ) longer than the other osteoporotic fractures group . CONCLUSION individuals with a history of clinical vertebral fracture seem to carry the greatest health burden compared with other fracture groups , emphasising the attention which should be given to those individuals CONTEXT There are few published long-term data on absolute risk of subsequent fracture ( refracture ) following initial low-trauma fracture in women and fewer in men . OBJECTIVE To examine long-term risk of subsequent fracture  following initial osteoporotic fracture in men and women . DESIGN , SETTING , AND PARTICIPANTS Prospect i ve cohort study ( Dubbo Osteoporosis Epidemiology Study ) in Australia of 2245 community-dwelling women and 1760 men aged 60 years or older followed up for 16 years from July 1989 through April 2005 . MAIN OUTCOME MEASURE Incidence of first ( initial ) fracture and incidence of subsequent fracture according to sex , age group , and time since first fracture . Relative risk was determined by comparing risk of subsequent fracture with risk of initial fracture . RESULTS There were 905 women and 337 men with an initial fracture , of whom 253 women and 71 men experienced a subsequent fracture . Relative risk ( RR ) of subsequent fracture in women was 1.95 ( 95 % confidence interval [ CI ] , 1.70 - 2.25 ) and in men was 3.47 ( 95 % CI , 2.68 - 4.48 ) . As a result , absolute risk of subsequent fracture was similar in women and men and at least as great as the initial fracture risk for a woman 10 years older . Thus , women and men aged 60 to 69 years had absolute refracture rates of 36/1000 person-years ( 95 % CI , 26 - 48/1000 ) and 37/1000 person-years ( 95 % CI , 23 - 59/1000 ) , respectively . The increase in absolute fracture risk remained for up to 10 years , by which time 40 % to 60 % of surviving women and men experienced a subsequent fracture . All fracture locations apart from rib ( men ) and ankle ( women ) result ed in increased subsequent fracture risk , with highest RRs following hip ( RR , 9.97 ; 95 % CI , 1.38 - 71.98 ) and clinical vertebral ( RR , 15.12 ; 95 % CI , 6.06 - 37.69 ) fractures in younger men . In multivariate analyses , femoral neck bone mineral density , age , and smoking were predictors of subsequent fracture in women and femoral neck bone mineral density , physical activity , and calcium intake were predictors in men . CONCLUSION After an initial low-trauma fracture , absolute risk of subsequent fracture was similar for men and women . This increased risk occurred for virtually all clinical fractures and persisted for up to 10 years Summary In the present prospect i ve controlled observational study , we investigated the effect of a coordinated intervention program on 4-year refracture rates in patients with recent osteoporotic fractures . Compared to st and ard care , targeted identification , and management significantly reduced the risk of refracture by more than 80 % . Introduction The risk of refracture following an incident osteoporotic fracture is high . Despite the availability of treatments that reduce refracture and mortality rates , most patients with minimal trauma fracture ( MTF ) are not managed appropriately . The present prospect i ve controlled observational study investigated the effect of a coordinated intervention program on 4-year refracture rates and time to refracture in patients with recent osteoporotic fractures . Methods Patients presenting with a non-vertebral MTF were actively identified and offered referral to a dedicated intervention program . Patients attending the clinic underwent a st and ardized set of investigations , were treated as indicated and review ed at 12-monthly intervals ( ‘ MTF group ’ ) . Patients who elected to follow-up with their primary care physician were assigned to the concurrent control group . Results Groups were balanced for baseline anthropometric , socio-economic , and clinical risk factors . Over 4 years , 10 out of 246 patients ( 4.1 % ) in the MTF group and 31 of 157 patients ( 19.7 % ) in the control group suffered a new fracture , with a median time to refracture of 26 and 16 months , respectively ( p < 0.01 ) . Compared to the intervention group , the risk of refracture was increased by 5.3-fold in the control group ( 95 % CI : 2.8–12.2 , p < 0.01 ) , and remained elevated ( HR 5.63 , 95%CI 2.73–11.6 , p < 0.01 ) after adjustment for other significant predictors of refracture such as age and body weight . Conclusions In patients presenting with a minimal trauma non-vertebral fracture , active identification and management significantly reduces the risk of refracture ( Australian New Zeal and Clinical Trials Registry ACTRN 12606000108516 ) UNLABELLED The level of recognition and treatment of osteoporosis is not well characterized in primary care . In data from a large sample of postmenopausal women attending 927 primary care physicians , 29 % of women reported one or more fractures after menopause . The great majority ( 72 % ) were not on any osteoporosis-specific therapy . INTRODUCTION Osteoporosis is often first recognized at the time of a low-trauma fracture . However , by this stage , the risk of subsequent fractures has already risen substantially . Moreover , in many countries , only a small proportion of women , who have already sustained fractures , receive a treatment shown to reduce this increased risk of further fractures . MATERIAL S AND METHODS This project was initiated to examine the prevalence of osteoporotic fractures , risk factors for osteoporosis , and use of antifracture therapy among postmenopausal Australian women . More than 88,000 women from 927 primary care physicians returned over 69,358 surveys . Of these , 57,088 reported the presence of a postmenopausal fracture or risk factors . RESULTS Among these r and omly selected postmenopausal women , 29 % reported having had one or more low-trauma fractures after menopause ( 44 % substantiated in current records ) . One-third of these women reported multiple fractures . The prevalence of all types of fractures , except rib and ankle , increased with age and low body weight . Those who reported fractures were also more likely to report early menopause , corticosteroid use , and a family history of osteoporosis . Moreover , those with vertebral fractures were more likely to record height loss , kyphosis , and back pain . Physical inactivity , low calcium intake , and smoking had no consistent relationship with any fracture outcome . Of the women who reported a fracture after menopause , only 28 % were on any specific therapy for osteoporosis , and 7 % were on calcium alone . Of those who had been told they had osteoporosis by a doctor , 40 % were receiving specific osteoporosis therapy . CONCLUSIONS In this large study of postmenopausal Australian women attending primary care physicians , 29 % reported at least one low-trauma fracture after menopause . Less than one-third of these women were on specific treatment for osteoporosis , and only 40 % were ever told they had osteoporosis . Therefore , osteoporotic fractures are common in postmenopausal Australian women , and few , despite their substantially increased risk of further fractures , are on any specific anti-osteoporotic therapy . These data support the need for more effective education for the community and medical practitioners of the clinical significance of osteoporotic fractures and alternatives for treatment BACKGROUND Vertebral fractures are common and usually an indication for osteoporosis treatment . However , screening is not recommended , and many fractures go undetected . Our objectives were to determine the utility of chest radiographs for detecting previously unrecognized vertebral fractures ; document rates of recognition ; and evaluate osteoporosis treatments . METHODS In 2001 , we conducted a cohort study in a r and om sample of 500 patients older than 60 years who presented to our emergency department and underwent chest radiography for any indication .  The primary outcome was prevalence of moderate-to-severe vertebral fractures determined by independent radiograph review using vali date d semiquantitative techniques . Secondary outcomes were rates of fracture recognition according to official radiologists ' reports and rates of osteoporosis diagnosis and treatment . We conducted multivariable regression analyses to determine correlates of study -defined and officially reported fractures . RESULTS We excluded 36 patients with inadequate radiographs and 5 for other reasons . Mean age was 75.2 years ; 47 % were women ; and 80 % were white . The prevalence of moderate-to-severe vertebral fractures according to independent review was 72 ( 16 % ) of 459 ; 29 ( 40 % ) of these fractures were not recorded in the official radiologists ' report ( kappa = 0.64 ; 95 % confidence interval [ CI ] , 0.53 - 0.75 ) . A history of osteoporosis was the only independent correlate of having a vertebral fracture identified by independent review ( adjusted odds ratio [ OR ] , 2.18 ; 95 % CI , 1.14 - 4.17 ) or by official report ( adjusted OR , 4.97 ; 95 % CI , 0.95 - 25.86 ) . Of the 72 patients with fractures , only 18 ( 25 % ) had histories of osteoporosis or received osteoporosis medications . CONCLUSIONS One in 6 elderly patients who underwent chest radiography in our emergency department had clinical ly important vertebral fractures . Nevertheless , only 43 ( 60 % ) of these fractures were reported , and only 25 % of patients with fractures received a diagnosis of or treatment for osteoporosis Context Many patients who sustain fragility fractures do not receive subsequent testing and treatment for osteoporosis . Contribution This study shows that faxed reminders to physicians , treatment guidelines endorsed by opinion leaders , and patient education about osteoporosis can increase the testing and therapy for osteoporosis among patients who present to an emergency department with wrist fracture . Caution s This study did not r and omly assign persons to the intervention group and did not examine improvements in bone density or repeated fractures . The Editors Osteoporosis , a chronic and progressive condition that leads to decreased bone mass and skeletal fragility , may result in fractures , disability , pain , deformity , and even death ( 1 - 3 ) . The condition is common , affecting an estimated 1.4 million Canadians and 10 million Americans ( 1 , 2 ) . These figures represent 25 % of women and 12 % of men older than 50 years of age ( 1 , 2 ) . In the United States , the annual cost of treating osteoporosis and its sequelae has been estimated at $ 13.8 billion ( 2 ) , compared with $ 7.5 billion for congestive heart failure and $ 6.2 billion for asthma ( 3 ) . Without better preventive strategies , the rate of osteoporotic fractures is expected to double over the next 15 years ( 4 ) . Several experts ( 5 ) and guidelines ( 1 , 2 ) suggest a preventive strategy of identifying people with typical osteoporosis-related fractures ( for example , fractures of the hip , spine , or wrist [ often called fragility fractures ] ) and targeting them for treatment . They recommend this strategy because this population is at the greatest risk for subsequent fracture and may derive the greatest absolute benefit from treatment . Numerous safe and effective treatments can reduce the risk for recurrent fracture by 40 % to 60 % ( 1 - 3 , 6 ) . In addition , with the use of bisphosphonates and raloxifene , all subgroups of examined patients may obtain beneficial effects ( 3 , 7 - 9 ) within a year ( 7 , 8) . People 50 years of age and older with a fracture of the wrist may be particularly well suited to a strategy of case finding and secondary prevention . Fractures of the wrist are the most common symptomatic fracture related to osteoporosis ( 3 ) , and 70 % to 80 % of persons with wrist fractures have low bone mass ( 10 , 11 ) . Observational studies suggest that a wrist fracture is a sentinel event in the natural history of osteoporosis because this type of fracture forecasts an increased risk for fractures of the hip and spine over the next 10 to 20 years ( 12 - 14 ) . Best practice ( clinical practice consistent with current evidence and expert consensus ) would be to identify people 50 years of age or older with a fragility fracture of the wrist , to measure their bone mineral density , and to treat those with low bone mass or osteoporosis ( 1 , 2 , 5 ) . However , the gap between best practice and everyday clinical practice is wide . Over the past 5 to 10 years , studies from the United States ( 3 , 15 , 16 ) , Canada ( 17 , 18 ) , and elsewhere ( 5 , 19 ) report that rates of testing for and treating osteoporosis a year or longer after a fracture of the wrist are less than 10 % to 20 % . This is an important failure in the process of knowledge translation and indicates that benefits within our reach are not being achieved . We design ed a pragmatic , multifaceted osteoporosis intervention strategy directed at people 50 years of age or older with a fracture of the wrist and at their primary care physicians . The intervention consisted of physician reminders , treatment guidelines endorsed by local opinion leaders , and patient education . Our primary objective was to examine whether this intervention improved the diagnosis and treatment of osteoporosis in this high-risk population . Secondary objectives included examining the effect of this intervention on patients ' knowledge , satisfaction , and quality of life . Methods Setting and Participants Capital Health ( Edmonton , Alberta ) is one of the largest integrated health service delivery organizations in Canada ( 20 ) . It provides comprehensive health services for about 1 million people and has an annual budget of almost $ 2 billion ( Canadian ) ( 20 ) . Primary care is delivered by approximately 900 fee-for-service physicians . We enrolled participants from the 2 largest emergency departments in the region : the University of Alberta Hospital ( a university-based teaching hospital ) and the Royal Alex and ra Hospital ( a university-affiliated community teaching hospital ) . These emergency departments provide most of the fracture care and emergency orthopedic services to the region . Consecutive patients presenting to the emergency department with a wrist fracture were potentially eligible . Inclusion criteria were as follows : age 50 years or older ; any simple , closed fracture of the distal forearm ; and discharge home . We excluded patients who were already taking prescription treatments for osteoporosis . Because we did not ask patients whether they had a diagnosis of osteoporosis until study closeout , a patient with a history of osteoporosis who was not being treated with prescription medication was potentially eligible for inclusion . We also excluded patients who were unable to provide consent , were unwilling to participate , were admitted to the hospital , resided in a long-term care facility , resided outside the Capital Health region , or could not read and converse in English . Study Design and Patient Enrollment We conducted a prospect i ve controlled trial with blinded ascertainment of outcomes . To allocate patients to the intervention or usual care control groups , we adapted and modified an onoff 1-site study design for 2 sites ( 21 ) . For 1 month at a time , in sequential order , the intervention was on at 1 emergency department while it was off at the other . At the end of each month , research nurses alternated intervention status from on to off or vice versa . Patients with wrist fractures were treated , as appropriate , by emergency department physicians and then approached by research nurses or orthopedic technicians for enrollment in the study before discharge home . We obtained informed consent from each patient , and all data were maintained outside the emergency departments in a central ized secure file system . The University of Alberta Health Research Ethics Board approved the study . Intervention We design ed an intervention to overcome the many barriers that exist for primary care physicians who are trying to adopt evidence -based treatments for their patients with osteoporosis . Each of the 3 components of the intervention had published evidence of effectiveness ( 22 - 24 ) . Physician Reminders A reminder was generated for each patient and faxed to the primary care physician of record . The reminder notified physicians that their patient had recently been seen and treated in the emergency department for a wrist fracture and reminded them that their patient was now considered to be at increased risk for osteoporosis . Generating and sending the personalized and patient-specific reminder took about 6 minutes for each patient . Treatment Guidelines Generated and Endorsed by Opinion Leaders As part of the reminder , we provided brief evidence -based treatment recommendations . These guidelines were design ed to fit on the same page and emphasized 3 points : 1 ) The patient is at very high risk for osteoporosis and needs a bone mineral density measurement if one has not been performed in the past year ; 2 ) without treatment , the patient may be at increased risk for another fracture within the year ; and 3 ) bisphosphonate treatment will reduce the patient 's risk for fracture by about 50 % . Bisphosphonate alternatives ( for example , calcitonin , raloxifene , and hormone therapy ) were mentioned as second-line approved treatments because , at the time of study design , only the bisphosphonates had been demonstrated to prevent both vertebral and nonvertebral fractures . Using previously vali date d methods ( 25 , 26 ) , we recruited 5 osteoporosis opinion leaders who had been nominated by local primary care providers . The opinion leaders helped develop and then endorsed the guidelines by attaching their names and signatures . Patient Education We provided patients in the intervention group with a tailored , single-page summary of osteoporosis information that mirrored the physician material s described in the preceding paragraph . We reinforced these written material s with a brief telephone counseling session that took place within 1 week of the fracture . This counseling ( approximately 4 minutes per session ) reiterated the content of the written material s and encouraged patients to seek further information and counseling from their primary care physician . We did not provide intervention patients with any written material s or counseling regarding fall prevention or home safety . Control Patients ( Usual Care ) On the basis of surveys and in-depth interviews with emergency department physicians in Canada and the United States , the current st and ard of care for patients treated for a wrist fracture usually consists of 1 ) notification to the primary care physician of record that the patient was seen and treated and 2 ) information on follow-up plans . We ensured that such notifications occurred for all control patients . In addition , we enhanced usual care by ensuring that control patients received educational material s and telephone counseling regarding fall prevention and home safety . During the call , patients were encouraged to visit their primary care physician for more detailed advice and a medication review . They did not receive any counseling or educational material s about osteoporosis . Thus , control patients received the same amount of attention and care as the intervention patients . After the main study was completed , all control patients were crossed over to the osteoporosis intervention , and all intervention patients were provided with counseling regarding fall prevention and home safety . Outcomes and Measurements The primary study outcome was Background and purpose Few economic or quality -of-life studies have investigated the long-term consequences of fragility fractures . This prospect i ve observational data collection study assessed the cost and quality of life related to hip , vertebral , and wrist fracture 13–18 months after the fracture , based on 684 patients surviving 18 months after fracture . Patients and methods Data regarding re source use and quality of life related to fractures was collected using question naires at 7 research centers in Sweden . Information was collected using patient records , register sources , and by asking the patient . Quality of life was estimated using the EQ-5D question naire . Direct and indirect costs were estimated from a societal st and point . Results The mean fracture-related cost 13–18 months after a hip , vertebral , or wrist fracture were estimated to be € 2,422 , € 3,628 , and € 316 , respectively . Between 12 and 18 months after hip , vertebral , and wrist fracture , utility increased by 0.03 , 0.05 , and 0.02 , respectively . Compared to prefracture levels , the mean loss in quality of life between 13 and 18 months after fracture was estimated to be 0.05 , 0.11 , and 0.005 for hip , vertebral , and wrist fracture . Interpretation The sample of vertebral fracture patients was fairly small and included a high proportion of fractures leading to hospitalization , but the results indicate higher long-term costs and greater loss in quality of life related to vertebral fracture than previously believed Although vertebral fractures are common among older women , little is known about associations with pain and disability . In this prospect i ve study , fractures which occurred after the initial radiograph were strong predictors of back pain and disability at the end of followup , with odds ratios ( OR ) of approximately 4 - 5 . Other , independently significant predictors were self-reported history of ( 1 ) disk disease ( OR = 3 - 9 ) , ( 2 ) traumatic back injury ( OR = 4 - 7 ) , and ( 3 ) spinal arthritis ( OR = 3 - 6 ) . In longitudinal analyses , new fractures were associated ( OR = 6.4 ; 95 % CI = 2.6 , 15.6 ) with increases in back pain frequency ( relative to pre-fracture levels ) . The association with prevalent fractures was weaker , and not significant ( OR = 1.7 ; 95 % CI = 0.5 , 5.6 ) . The pain frequency index increased approximately 3-fold , relative to pre-fracture levels . At the end of followup ( mean = 3.5 years ) , the index was still two times greater than baseline . We conclude that associations with back pain and disability are greater in magnitude for new vertebral fractures than for prevalent fractures BACKGROUND Distal radius fracture is recognized as an osteoporosis-related fracture in aged population . If another osteoporosis-related fracture occurs in a short period , it represents a prolonged hospitalization and a considerable economic burden to the society . We evaluated the relationship between distal radius fracture and subsequent hip fracture within 1 year , especially in the critical time and age . METHODS We identified newly diagnosed distal radius fracture patients in 2000 to 2006 as an exposed cohort ( N = 9,986 ) . A comparison cohort ( N = 81,227 ) was r and omly selected from patients without distal radius fracture in the same year of exposed cohort . The subjects were followed up for 1 year since the recruited date . We compared the sociodemographic factors between two cohorts . Furthermore , the time interval following the previous distal radial fracture and the incidence of subsequent hip fracture was studied in detail . RESULTS The incidence of hip fracture within 1 year increased with age in both cohorts . The risk was 5.67 times ( 84.6 vs. 14.9 per 10,000 person-years ) greater in the distal radial fracture cohort than in the comparison cohort . The multivariate Cox proportional hazard regression analyses showed the hazard ratios of hip fracture in relation to distal radial fracture was 3.45 ( 95 % confidence interval = 2.59–4.61 ) . The highest incidence was within the first month after distal radial fracture , 17-fold higher than the comparison cohort ( 17.9 vs. 1.05 per 10,000 ) . Among comorbidities , age > 60 years was also a significant factor associated with hip fracture ( hazard ratio = 8.67 , 95 % confidence interval = 4.51–16.7 ) . CONCLUSIONS Patients with distal radius fracture and age > 60 years will significantly increase the incidence of subsequent hip fracture , especially within the first month . LEVEL OF EVIDENCE Prognostic/epidemiologic study , level II Background : Hip fracture patients are reported to have an increased mortality rate compared to the general population . In order to be able to reduce the morbidity and mortality after a hip fracture , our efforts to identify the patients at risk already upon admission to the hospital need to be increased . For such a risk assessment , robust , vali date d , and reproducible criteria are m and atory . Objective : To determine preoperative factors associated with mortality and to evaluate the combined use of the American Society of Anesthesiologists ( ASA ) and the  Short Portable Mental Status Question naire ( SPMSQ )  to identify patients with an increased mortality rate and to create a predictive model to assess the mortality risk after hip fracture surgery . Methods : A total of 1,944 consecutive patients aged 66 years or older admitted for a hip fracture were included in a prospect i ve cohort study with a 24-month follow-up . The patients were assessed with regard to gender , age , type of hip fracture , smoking habits , comorbidities , general physical health according to the ASA classification , and cognitive function according to the SPMSQ . A higher ASA score indicates an increasingly severe systemic disease and a lower SPMSQ score indicates an increasingly severe cognitive dysfunction . We used Cox proportional hazard models and classification trees to identify the factors associated with mortality . The predictive model was created based on factors that were significantly associated with death and all readily accessible upon admission . Results : The mortality rate during the acute hospitalization period was 4 % , at 4 months 16 % , and at 24 months 38 % . The most prominent factors associated with mortality were high ASA scores , low SPMSQ scores , high age and male gender . The SPMSQ score provided additional information about the survival time , compared to when the ASA score was used alone . Conclusion : The combined use of the ASA classification for assessing physical health and the SPMSQ for assessing cognitive function effectively identified hip fracture patients with an increased mortality rate . We present a predictive model including age , gender , ASA , and SPMSQ that can be used to assess the mortality risk after hip fracture surgery
target: Vertebral fracture caused the greatest health burden , but hip fracture patients were the main users of informal care after hospital discharge .
  There was an increased risk of a subsequent fracture after a primary fracture compared with the control group , a cohort comparison , or the general population .
  Osteoporotic fractures , especially hip fractures , are associated with higher mortality rate despite the advances in the management of osteoporotic fracture cases .
  There is strong evidence to show that after hospital discharge , osteoporotic fracture patients are faced with higher morbidity , subsequent fractures , and mortality
background: PURPOSE Osteoporotic fracture is the main complication of osteoporosis .
  The current management is to discharge patients as early as possible so they can get back to their daily activities .
  Once discharged , there are three main issues relating to morbidity , mortality , and risk of a subsequent fracture that need to be addressed and discussed .
  Therefore , the aim of this systematic review was to summarize and evaluate the evidence from published literature , to determine the outcome of osteoporotic fracture patients after their hospital discharge .