ACR Meeting Abstracts

ACR Meeting Abstracts

Abstract Number: 2323

Predictors of Mortality in Patients with Hip Fragility Fracture

Miguel Guerra1, Sara Ganhão2,3, Francisca Aguiar2,3, Georgina Terroso2, Romana Vieira1, Diana Gonçalves4, Tiago Meirinhos5, Teresa Martins-Rocha2,3, Ana Águeda3,5, Raquel Ferreira2,3, Miguel Bernardes2,3, Carlos Vaz2,3, Raquel Lucas6 and Lúcia Costa2, 1Rheumatology, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal, 2Rheumatology, Centro Hospitalar de São João, Oporto, Portugal, 3Faculty of Medicine, Oporto University, Oporto, Portugal, 4Rheumatology, Centro Hospitalar de Trás-os-Montes e Alto Douro, Vila Real, Portugal, 5Rheumatology, Centro Hospitalar do Baixo Vouga, Aveiro, Portugal, 6Public Health Institute of Oporto University, Oporto, Portugal

Meeting: 2018 ACR/ARHP Annual Meeting

Keywords:

Session Information

Date: Tuesday, October 23, 2018

Title: Osteoporosis and Metabolic Bone Disease – Basic and Clinical Science Poster

Session Type: ACR Poster Session C

Session Time: 9:00AM-11:00AM

Background/Purpose:

In Osteoporosis, hip fractures account for significant disease burden, with increased morbi-mortality and financial load on the patient and healthcare system. This study aimed to assess cumulative survival rate of patients with hip fragility fracture aged >= 65 years old, referred to a Rheumatology Department’s Fracture Liaison Service (FLS) after admission to the Orthopaedics Inpatient Care Department, and to determine predictors of mortality.

Methods:

Longitudinal retrospective study of patients referred to a Rheumatology Departmenrt’s FLS from March 2015 until March 2017. Demographic and clinical data were collected. Statistical analysis was performed with STATA. Survival cumulative probabilities were calculated through Kaplan-Meyer curves and hazard ratios (HR) through cox regression, adjusted to age/degree of care dependency.

Results:

522 patients were referred to the FLS, 79.7% female, with median age of 84 years old (65-103). Table 1 summarizes clinical and demographic characteristics. One hundred and nineteen patients (22.8%) died, 36 still during inpatient care. The cumulative survival probability (image 1) at 1, 3, 6, 12 and 24 months was 94.1% (95%CI 91.7-95.9), 91.1% (95%CI 88.2-93.3), 86,3% (95%CI 82.9-89.0%), 81.7 (95%CI 77.9-84.8) and 73.8% (95%CI 69.2-77.8) respectively. Patients >=80 years old presented lower survival rate (HR 1.64, p=0.02), as well as partially dependent and totally dependent patients (HR 1.93, p=0.047; HR 5.3, p=0.000, respectively). Higher femur BMD (HR 0.01, p=0.023) and T-score (HR 0.67, p=0.038) were predictors of better survival outcome. Considering laboratory measurements, higher beta-crosslaps serum values predicted worse survival outcome (HR 4.27, p=0.007). Gender, fracture classification, type of surgical intervention, presence of vertebral fractures, BMI, serum vitamin D and osteocalcin didn’t have impact on survival.

Conclusion:

Knowledge of mortality predictors in hip fracture is essential to optimize survival in these patients. In our study, age, autonomy degree, femur BMD/T-score and beta-crosslaps had impact on survival outcome.

Table 1 – Clinical and demographic characteristics of sample

Total (N)

522

Age at admission, y (median, min-max)

84 (65-103)

Sex, female (n, %)

416, 79.7

Deaths (n, %)

During inpatient care (n, %)

119, 22.8

36, 6.9

BMI (N)

Underweight (n, %)

Normal (n, %)

Overweight (n, %)

Obesity class I (n, %)

218

80, 36.7

117, 53.7

20, 9.2

1, 0.5

Degree of care dependency (N)

Totally dependent (n,%)

Partially dependent (n,%)

Autonomous (n,%)

307

23, 7.5

78, 25.4

206, 67.1

Type of fracture

Transtrochanteric (n,%)

Femoral neck (n,%)

Subtrochanteric (n,%)

262, 50.2

221, 42.3

38, 7.3

Subsequent fracture (n,%)

47, 9.0%

Vertebral fracture (N)

0 (n,%)

1 fracture (n,%)

>= 2 fractures (n,%)

236

100, 42.4

56, 25.9

80, 33.9

Femur BMD, g/cm2 (median, min-max, N)

0.70, 0.36-1.18, 214

Femur T score (median, min-max, N)

>2.5 (n,%)

<=2.5 (n,%)

-2.6, -7.0-0.7, 214

87, 40.7

127, 59.3

Intervention (N)

Conservative (n,%)

Osteosynthesis (n,%)

Hemiarthroplasty (n,%)

Total arthroplasty (n,%)

Girdlestone (n,%)

516

11, 2.1

337, 65.3

87, 16.9

80, 15.5

1, 0.2

25(OH)D, ng/ml (median, min-max, N)

23, 3-54, 219

OC ng/ml (median, min-max, N)

28.2, 6.80-198.60, 215

Beta-crosslaps (median, min-max, N)

0.71, 0.12-3.28, 217

Image 1 – Cumulative survival probability of study sample

Disclosure: M. Guerra, None; S. Ganhão, None; F. Aguiar, None; G. Terroso, None; R. Vieira, None; D. Gonçalves, None; T. Meirinhos, None; T. Martins-Rocha, None; A. Águeda, None; R. Ferreira, None; M. Bernardes, Pfizer, Inc., 9,Lilly, 9,Janssen, 9,Merck & Co., 9,GlaxoSmithKline, 9; C. Vaz, None; R. Lucas, None; L. Costa, None.

To cite this abstract in AMA style:

Guerra M, Ganhão S, Aguiar F, Terroso G, Vieira R, Gonçalves D, Meirinhos T, Martins-Rocha T, Águeda A, Ferreira R, Bernardes M, Vaz C, Lucas R, Costa L. Predictors of Mortality in Patients with Hip Fragility Fracture [abstract]. Arthritis Rheumatol. 2018; 70 (suppl 9). https://acrabstracts.org/abstract/predictors-of-mortality-in-patients-with-hip-fragility-fracture/. Accessed .

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