Having specific combinations of underlying health issues is a significant risk for poorer health outcomes in older adults who have had a fracture, a new study from the Garvan Institute for Medical Research shows.
The study was conducted on more than 300,000 Danes aged 50 and over who had suffered a fracture. In patients with fractures closer to the center of the body (for example, in the hip, back, upper arm or leg), the researchers found a higher mortality rate than expected for the general population of the same age. If those people with fractures also had multiple or complex health conditions, the risk of mortality was higher again.
The researchers found that certain groups of conditions were associated with increased mortality rates, suggesting that this information could be used by clinicians to highlight patients who may require more intensive medical care.
This is an important study that could really change the way in which we provide medical treatment to older adults. It could potentially be a new way of thinking about how we look at people with fractures, considering the fracture site in light of their specific underlying health conditions.”
Professor Jacqueline Center, Head of the Laboratory of Clinical Studies and Epidemiology and Lead Author of the Study
The new study is published in the journal JAMA Network Open.
Typically, the management of health conditions such as osteoporosis, heart disease or diabetes is considered in terms of the individual disease. However, these new findings suggest that looking at clusters of underlying conditions may indicate that someone is at high risk for poorer outcomes, over and above the risk from the condition being treated.
The researchers found that chronic health conditions at the time of fracture naturally clustered into five specific groups for men and four for women: a relatively healthier group with generally only one or no health conditions, a cardiovascular group, a diabetic group, and a cancer group . with an additional liver/inflammatory group for men.
Visiting scientist Robert Blank adds: “It’s not good enough to count other diseases. You have to take into account their severity and their combinations. Many patients with a history of previous cancer, for example, were not in what we call the cluster of cancer. , but the cancer group included almost all those with evidence of advanced cancer. The same type of classification by severity was observed in the other groups.”
Interestingly, a fracture located closer to the center of the body, such as the bones of the hip, vertebrae or upper arm, had a higher risk of mortality. In contrast, those in the healthy group who had fractures farther up the body, such as hands and forearms, had virtually no increase in mortality.
The presence of specific sets of health conditions in people made the chance of death after these fractures much greater than the fractures or health conditions alone. For example, the mortality rate after hip fracture among men in the cancer group was 41% higher than age-matched men in the general community. And diabetes in otherwise healthy people was not associated with increased mortality risk, but diabetes in combination with heart, vascular, or kidney disease was.
“This research highlights that there is an interaction between fracture and a patient’s set of health conditions – their underlying health – and that this can be a good way to identify people at risk,” says Dr Thach Tran of Garvan, author of first study “We can identify people who are likely to go wrong. Importantly, findings from this research may be applicable to many disease settings in which sentinel events occur with pre-existing health disorders.”
It is not understood why the link exists between multiple underlying conditions, the type of fracture and poor outcomes, but Professor Center thinks it may be the interaction with bone and the immune system. “Bone is not inert. When you break a bone, you get increased bone turnover and associated inflammatory factors, and I suspect that in underlying disease, this process is not well controlled, and a fracture can promote underlying health problems,” she says.
The next steps are to determine if these clusters are seen in other diseases – if they are universal – and if they can be used as a predictive tool for doctors.
Tran, T., et al. (2022) Association of multimorbidity and excess mortality after fractures among Danish adults. JAMA Network Open. doi.org/10.1001/jamanetworkopen.2022.35856.
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