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Elderly men at elevated risk of post-spinal fracture mortality

Roshini Claire Anthony
12 Apr 2019

Elderly men who sustain acute spine fractures may be at an elevated risk of mortality 1 year after the fracture, according to a study from Singapore.

“An older age at presentation, the male sex, and an ASIA* score of A–C were independent factors predictive of increased mortality among geriatric patients who sustained acute spine fractures. Considering the associated morbidity and mortality, preventing spine fractures in the elderly is a cornerstone in maintaining their quality of life,” said the researchers.

The researchers reviewed data of 3,010 patients who were admitted to Tan Tock Seng Hospital between 2004 and 2015 for traumatic acute spine fractures, of whom 613 patients aged >80 years with acute spinal compression fractures were included in this study (mean age 85.7 years, 82.38 percent female, 91.84 percent Chinese). About 42 percent of patients had a history of osteoporotic fractures of the spine, hip, and/or forearm.

Falls were the most common cause of spine fractures (77.81 percent) and a majority of the patients had ASIA score E (71 percent). Most patients (95.43 percent) were managed conservatively. The average duration of hospitalization was 12.2 days. [Asian Spine J 2019;doi:10.31616/asj.2018.0231]

One year following hospitalization, mortality rate was 10.4 percent, rising from 6.0 and 8.2 percent at 3 and 6 months, respectively. The most frequent causes of death at 1 year were pneumonia (28.6 percent), ischaemic heart disease (22.2 percent), and metastatic cancer (15.9 percent).

“Patients with acute spine fractures are likely to have greater pain, leading to immobility and thereby predisposing them to pneumonia,” said the researchers.

At 1 year, risk of mortality was influenced by sex, with elderly women having a lower mortality risk than elderly men (hazard ratio [HR], 0.340, 95 percent confidence interval [CI], 0.200–0.579; p<0.001), and age at hospital admission, where every 1 additional year of age raised the mortality risk by 6.3 percent (HR, 1.063, 95 percent CI, 1.008–1.120; p=0.024). An ASIA score of A–C was also associated with a higher mortality risk than a D–E score (HR, 12.363, 95 percent CI, 4.727–32.340; p<0.001).

“An ASIA score of A–C indicates severe neurological compromise due to spinal cord injury. With its expected resultant morbidity, there is a greater likelihood of mortality,” said the researchers. Furthermore, 80 percent of the patients who underwent surgery had ASIA score D–E. The lower mortality risk could be attributed to a lower perioperative risk among patients chosen for surgical treatment, or that patients who underwent surgery recovered faster than conservatively-treated ones.

Age leads to deterioration of posture, vision, and vestibular dysfunction, and is associated with comorbidities such as osteoarthritis and neurodegenerative disorders, all of which can increase the risk of falls, said the researchers. These, coupled with the high incidence of osteoporosis, further increases their risk of fractures. [Am Fam Physician 2000;61:2159-2168,2173-2174; Medicine (Baltimore) 2017;96:e8294]

Due to the propensity for spine fractures among elderly women, the researchers suggested that this population be the target for interventions to reduce the risk of acute spinal fracture, particularly with regard to preventing falls and reducing osteoporosis incidence.

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