Mortality After Hip Fracture Beyond the First Year
Mortality after hip fracture remains elevated beyond the first year, with cumulative death rates reaching 15-30% by one year post-surgery, and the increased mortality risk persists for several years thereafter, though it becomes less pronounced over time. 1, 2
First-Year Mortality Rates
The mortality burden is substantial and well-documented across multiple guidelines:
- Up to 15-30% of patients die within one year of hip fracture surgery, representing a three-fold increase compared to the general geriatric population 1, 2
- The 30-day mortality stands at 8.4%, with up to half of these deaths potentially preventable 1, 2
- Mortality is highest in the immediate post-fracture period and gradually decreases but remains elevated throughout the first year 1, 3
Beyond the First Year
While the provided guidelines focus primarily on first-year outcomes, the evidence indicates:
- The increased relative risk for mortality remains elevated for months and perhaps even years following the index fracture, though it becomes less pronounced with time 3
- Patients face a 3- to 4-fold increased risk of mortality in the 5 years following any fragility fracture 1
- The excess mortality risk may persist for several years after hip fracture, highlighting the need for long-term interventions 3
Risk Factors for Higher Mortality
Several patient characteristics predict worse outcomes:
- Male sex is associated with significantly higher mortality (38% in men vs 24% in women at one year for hip fractures) 1, 2
- Advanced age (particularly ≥86 years) correlates with the highest mortality rates 2
- Greater comorbidity burden and frailty increase death risk 1, 2
- Sarcopenia is the strongest predictor of out-of-hospital mortality (hazard ratio 4.77) 2
Causes of Death
The leading causes of mortality after hip fracture include:
- Pneumonia (19.4% of deaths within 2 years) 4
- Cardiovascular diseases (16% of deaths) 4
- Dementias (13.9% of deaths) 4
- Only 3.2% of deaths are directly attributable to the hip fracture or surgery itself, though functional decline and decompensation of chronic illness represent indirect causes 4
Clinical Implications
The persistently elevated mortality risk beyond one year emphasizes that hip fracture is not merely an orthopedic event but a marker of overall health decline 1, 3. This underscores the critical importance of:
- Secondary fracture prevention, as subsequent fragility fractures carry particularly poor prognosis 1
- Long-term monitoring and management of comorbidities 4
- Aggressive prevention of pneumonia and functional decline 4
- Early surgical intervention (within 24-48 hours) to optimize outcomes 2, 5
Note that there is no significant difference in mortality between left versus right hip fractures—the side of fracture does not influence outcomes, and all hip fractures should be managed with equal urgency 1, 5.