Fractures are not trivial for seniors, recalls a new study led by a researcher from Laval University, since they are associated with a very high risk of mortality during the month following the injury.
And even though hip fractures, with good reason, are usually those about which we worry the most for our elderly loved ones, they are far from being the only ones to represent an often unsuspected threat to their well-being and survival. warns the head of the study.
“It’s unfortunate to say, but we often hear: ‘it’s normal, your mother is 88 years old, she fractured her hip, you know, you have to die of something,’” denounced Doctor Jacques P. Brown, who is a clinical professor at the Faculty of Medicine of Laval University and a researcher at the Research Center of the CHU de Québec – Laval University. This is often the attitude that people have. »
However, these are patients for whom, with appropriate care, we could perhaps avoid a second fracture, with all that this represents as a burden for the health system, but we still need to “direct them to the right place”. place rather than telling them: “well listen, it’s normal, you were 88 years old, you should avoid falling next time”. These are great opportunities that are being lost,” said the researcher.
Dr. Brown and his colleagues used Ontario data to compare nearly 100,000 subjects aged 66 to 105 who had suffered a bone fracture to identical subjects without injury.
Hip fractures are the most devastating. Five years after such an injury, 45% of women were still alive, 24 percentage points lower than what was found in the comparison group. Vertebral fractures and proximal fractures (pelvis, femur, sternum, rib, humerus, shoulder) also considerably reduce the chances of survival over a five-year horizon.
“These are fractures that require a lot of immobilization in bed, so they tend to get complicated,” explained Dr. Brown, a situation that will often aggravate already existing health problems.
Distal fractures (tibia, fibula, knee, radius, ulna and wrist) are the least threatening in this regard, with a difference of only four percentage points between the two groups, possibly because they “will cause less disability functional to patients, less bed rest, less immobilization, therefore fewer immediate complications,” he added.
Not surprisingly, the worst survival rates were measured in men and in older patients.
After the age of 50, Dr. Brown recalled, approximately three-quarters of fractures that occur in daily life are associated with osteoporosis, for both men and women.
However, taking medications to treat osteoporosis reduces the risk of new hip fractures by 40% over three years and the risk of vertebral fractures by 70% over one year, he noted.
“We realized that when you have one fracture, you are likely to quickly get a second one which also increases your risk in the short term,” said Dr. Brown. We observed that during two and a half years of follow-up, 20% of our cohort had presented another bill after leaving the hospital environment. »
The year, and more specifically the month, following the fracture are particularly critical periods, since we then see a rapid drop in the survival rate when there has been a hip fracture, fracture of the vertebrae or proximal fracture.
The peak of death occurs in the first four to six weeks after the fracture, Dr. Brown continued. Considering that patients may be hospitalized for a similar period of time before being transferred to a rehabilitation center, this is a “missed” opportunity, he considers.
“We are losing a golden opportunity, at a time when they have not yet left the hospital, to tell them that they have a disease (osteoporosis) and to refer them to their family doctor for an evaluation and to initiate a treatment that exists, that is accessible free of charge and that could possibly prevent (the second fracture),” said Dr. Brown.
The findings of this study were published by the Journal of Bone and Mineral Research Plus.