Injury - 2026-05-07 - Journal Article
One-year mortality after first-time long bone fractures in older adults: A multicenter retrospective cohort study.
Ghafarian AM, Wajahath M, McBee K, Nasser E, Ghali A
Topics
Key Takeaway
All long bone fractures in adults ≥65 carry significantly elevated one-year mortality versus matched controls (baseline 2.77%), ranging from 5.6% for distal humerus (RR 1.63) to 27.9% for hip fractures (RR 4.86).
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Summary
This study used the TriNetX US Collaborative Network to compare one-year all-cause mortality across eight long bone fracture types in adults ≥65 versus propensity score-matched non-fracture controls (2004–2024). After 1:1 matching, all fracture types demonstrated significantly elevated mortality: hip fractures highest at 27.9% (RR 4.86), pertrochanteric 23.9% (RR 4.14), subtrochanteric 15.2% (RR 2.98), distal femur 9.4% (RR 2.71), and upper/lower extremity fractures 5.6–7.1% (RR 1.63–1.97). Even fractures traditionally considered lower-acuity—distal humerus, distal tibia, proximal tibia, proximal humerus—conferred roughly double the one-year mortality of matched controls.
Key Limitation
The database design precludes differentiation between operative and nonoperative management, meaning mortality differences may partly reflect treatment selection bias rather than fracture type alone.
Original Abstract
BACKGROUND
Fragility fractures represent a major public health concern in the aging population, contributing substantially to morbidity, functional decline, and mortality. Although hip fractures are widely recognized for their high early mortality risk, less is known about the comparative one-year mortality associated with first-time long bone fractures at other anatomical sites. This study evaluates one-year all-cause mortality across multiple fracture types in older adults using a large, multicenter research network.
METHODS
We performed a retrospective cohort study using the TriNetX US Collaborative Network, identifying patients ≥ 65 years with a first-time long bone fracture between 2004 and 2024. Fracture types included hip, pertrochanteric, subtrochanteric, distal femur, proximal tibia, distal tibia, proximal humerus, and distal humerus fractures. Patients with pathologic, metastatic, or multiple fractures were excluded. A non-fracture cohort of age-matched older adults served as the comparison group. The primary outcome was one-year all-cause mortality. Propensity score matching (1:1) was used to balance demographics. Relative risks (RR) with 95% confidence intervals (CIs) and Kaplan-Meier survival analyses were performed.
RESULTS
A total of 165,017 fracture patients and 4.55 million non-fracture controls were identified; 162,469 patients remained after matching per cohort. All fracture types were associated with significantly increased one-year mortality compared with matched controls (2.77%). Hip fractures demonstrated the highest risk (27.9%; RR 4.86, 95% CI 4.65-5.08), followed by pertrochanteric (23.9%; RR 4.14) and subtrochanteric fractures (15.2%; RR 2.98). Distal femur fractures carried a 9.4% mortality risk (RR 2.71). Mortality for distal humerus, distal tibia, proximal tibia, and proximal humerus fractures ranged from 5.6 to 7.1% (RR 1.63-1.97).
CONCLUSION
First-time long bone fractures in older adults are associated with significantly elevated one-year mortality, with hip and proximal femur fractures conferring the greatest risk. These findings underscore the need for early risk stratification, targeted postoperative care, fall-prevention strategies, and multidisciplinary management to reduce fracture-related mortality in the geriatric population.