Long-term refracture and mortality assessment in fractured elderly individuals: an evidence-based analysis based on T.A.R.Ge.T data

Abstract

Purpose: The aim of this study was to estimate the incidence of fracture and refracture in the elderly, along with the risk of refracture and mortality among elderly fractured individuals. Methods: An observational cohort study was carried out based on the healthcare administrative database of the Tuscany region (Italy). Individuals aged ≥65 years with a hospital discharge diagnosis of hip fracture identified between 1st January 2010 and 31st December 2016 were selected. Those presenting a diagnosis of neoplasia or Paget’s disease were excluded from the analysis. Crude and age- and sex-standardized annual incidences of fracture (95% confidence intervals) were estimated. During the follow-up the cumulative incidence of refracture was assessed among fractured individuals. Lastly, the risks of refracture, death after fracture, and death after refracture were assessed in the study cohort by using a competing risk model. Results: Overall, the standardized incidence of fracture remained stable, changing from 7.41 (95% CI: 7.21–7.61) in 2010 to 7.10 (95% CI: 6.93–7.27) in 2017. Higher incidence rates of fracture were observed among females and older individuals. The one-year cumulative incidence of refracture decreased slightly from 2010 (35 per 1,000 inhabitants) to 2016 (26.7 per 1,000 inhabitants). For those with a longer follow-up, a cumulative increased risk over time was observed. The competing risk analysis showed an increase in mortality risk in the study population, from 21% at the first to 49% at the fifth year. Similar patterns were observed for refracture (from 1% to 4%) and mortality risk after refracture (from 0.4% to 4%). Events in males, although less frequent than in females, were more likely to have a fatal outcome. Conclusion: Our findings confirm previous epidemiological investigations reporting a higher risk of refracture and of mortality in elderly individuals. Future studies should be performed in order to assess the impact of demographic and clinical factors on the observed phenomena.