From the Guidelines
The mortality rate within one year after a hip fracture is approximately 22-33%, with women having a 1-year mortality rate of 22% and men having a 1-year mortality rate of 33%. This means that about one in five to one in three people who suffer a hip fracture will die within the first 12 months following their injury, as reported in a study published in the Journal of the American College of Radiology in 2019 1. The risk is highest in the first few months post-fracture. Some key factors that contribute to the high mortality rate include:
- Age, with older patients being at higher risk
- Sex, with men having a higher mortality rate than women
- Presence of multiple comorbidities
- Poor pre-fracture functional status The causes of death are often related to complications such as:
- Infections, particularly pneumonia
- Cardiovascular events
- Thromboembolism Early surgical intervention, comprehensive geriatric assessment, appropriate pain management, early mobilization, and multidisciplinary rehabilitation can help reduce mortality risk, as emphasized in the study 1. Preventing falls and maintaining bone health through adequate calcium, vitamin D, and appropriate osteoporosis treatment are crucial for those who survive the initial fracture, as they face an increased risk of subsequent fractures.
From the Research
Mortality Rate After Hip Fracture
- The mortality rate after hip fracture is a significant concern, with various studies reporting different percentages of people who die within a year of hip fracture 2, 3, 4, 5.
- A study published in 2014 found that 30% of patients with hip fracture died within the first year, with the main cause of death being sepsis 2.
- Another study published in 2019 reported that recent 1-year mortality rates appear lower than traditional figures, with a consistent worldwide reduction in mortality at 1-year post hip fracture 3.
- A review of articles published over a twenty year period (1999-2018) found that one-year mortality has reduced from an overall mean of 27% (1960s) to 20% (2010s) 4.
- A large population-based sample of older persons across eight cohorts found that hip fracture was associated with excess short- and long-term all-cause mortality, with a hazard ratio of 2.12 after adjusting for potential confounders 5.
Causes of Mortality
- The causes of mortality after hip fracture vary depending on the postoperative period and the patients' comorbidities 6.
- In the 30-day postoperative period, the most common causes of death are acute processes such as bacterial and aspiration pneumonia, followed by myocardial infarction, cancer, gastrointestinal hemorrhage, stroke, pulmonary embolism, and acute renal failure 6.
- In the 6-month and 1-year postoperative period, chronic processes appear to be the most important causes of death, as well as decompensation of patients' chronic diseases 6.
Trends and Geographical Variations
- The management of hip fractures has advanced significantly over the past sixty years, with improvements in preventative planning, medical management, specialised orthogeriatric units, and surgical urgency 4.
- Despite these advancements, geographical variations in mortality rates still exist, with some regions reporting higher mortality rates than others 4, 5.
- A study published in 2017 found that hip fracture was associated with excess short- and long-term all-cause mortality in both sexes, with a stronger association amongst men than amongst women 5.