Excess short- and long-term mortality risk following any and hip fractures: a prospective matched cohort study using exposure density sampling

Evidence on the magnitude and duration of short- and long-term mortality following osteoporotic fractures was mixed. We aimed to examine the short- and long-term mortality risk after any and hip fractures. We conducted an “exposure density sampling” dynamically matched cohort study based on 363,884 adults of UK Biobank. A total of 19,163 any fracture and 3,114 hip fracture cases were included, and controls were matched 1:4 on age, sex, and frailty status. A piecewise Cox proportional hazards model was used to estimate mortality risk in different time periods from 30 days to 10 years after fractures. Among 86,685 any fracture cases and matched controls, the mean age (SD) was 58.3 (7.8) years, and 59.5% were women. During follow-up, men had a higher post-fracture mortality rate than women (15.85 vs 8.58 per 1,000 person-years). After adjustment, mortality risk peaked within the first 30 days following any fractures (HR = 23.31, 95% CI, 17.08–31.83), gradually declining but remaining elevated for up to 10 years (1.44, 1.08–1.91). Similar association patterns were observed for hip fractures. The above associations were consistently observed across various characteristics of the participants. This study underscores the importance of enhancing fracture prevention and early intervention, as well as long-term care.