Background
Methods
Study cohort
Hip fracture and mortality after hip fracture
Predictors
Statistical analyses
Results
Hip fracture risk factors
Characteristic | AD cohort N = 67,072 | Non-AD cohort N = 67,072 |
P
|
---|---|---|---|
Age at baseline, mean (95% CI) | 79.9 (79.8–79.9) | 79.9 (79.8–79.9) | matched |
Age at first fracture during the follow-up | 84.1 (83.9–84.3) | 86.3 (86.1–86.5) | <0.001 |
Sex | |||
Men | 43158 (64.3) | 43158 (64.3) | matched |
Women | 23914 (35.7) | 23914 (35.7) | |
Highest occupational social class before follow-up | |||
Managerial/professional | 14072 (21.0) | 14454 (21.5) | <0.001 |
Office worker | 5608 (8.4) | 5629 (8.4) | |
Farming/forestry | 12735 (19.0) | 13160 (19.6) | |
Sales/industry/cleaning | 28669 (42.7) | 26180 (39.0) | |
Unknown | 5470 (8.2) | 5186 (7.7) | |
Did not respond | 518 (0.8) | 2463 (3.7) | |
Hip replacement | 2219 (3.3) | 1001 (1.5) | <0.001 |
Knee replacement | 105 (0.2) | 67 (0.1) | 0.004 |
Cardiovascular disease | 34046 (50.8) | 32841 (49.0) | <0.001 |
Stroke | 6356 (9.5) | 5232 (7.8) | <0.001 |
Diabetes | 8969 (13.4) | 7527 (11.2) | <0.001 |
Asthma/COPD | 5846 (8.7) | 6011 (9.0) | 0.11 |
Cancer treatment | 792 (1.2) | 855 (1.3) | 0.12 |
Any mental or behavioural disorder | 15365 (22.9) | 5917 (8.8) | <0.001 |
Any CVD medication | 57603 (85.9) | 54704 (81.6) | <0.001 |
Drugs for obstructive airway diseases | 15895 (23.7) | 15991 (23.8) | 0.54 |
Hormone therapy use | 4429 (6.6) | 4213 (6.3) | 0.16 |
Bisphosphonates | 8932 (13.3) | 7460 (11.1) | <0.001 |
Proton pump inhibitors | 22281 (33.2) | 21760 (32.4) | 0.002 |
Anti-Parkinson drugs | 2349 (3.5) | 1959 (2.9) | <0.001 |
Antiepileptics drugs | 6729 (10.0) | 5697 (8.5) | <0.001 |
Antipsychotics | 11127 (16.6) | 5364 (8.0) | <0.001 |
Antidepressants | 23044 (34.4) | 13821 (20.6) | <0.001 |
Benzodiazepines and related drugs | 29368 (43.8) | 25915 (38.6) | <0.001 |
Opioids | 28907 (43.1) | 25742 (38.4) | <0.001 |
Risk factor | Category | AD cohort | Non-AD cohort | ||||
---|---|---|---|---|---|---|---|
IR/ 100 PY | Unadjusted HR (95% CI) | Adjusted HRa (95% CI) | IR/ 100 PY | Unadjusted HR HR (95% CI) | Adjusted HRa HR (95% CI) | ||
Age at baseline, increase per year | 1.07 (1.06–1.07) | 1.06 (1.06–1.07) | N.A | 1.12 (1.11–1.12) | 1.12 (1.11–1.13) | ||
Sex | Men | 2.50 | 1.00 (reference) | 1.00 (reference) | 1.05 | 1.00 (reference) | 1.00 (reference) |
Women | 1.58 | 0.63 (0.59–0.68) | 0.73 (0.68–0.78) | 0.64 | 0.61 (0.56–0.67) | 0.76 (0.69–0.84) | |
Highest occupational social class before follow-up | Managerial/professional | 1.83 | 1.00 (reference) | 1.00 (reference) | 0.66 | 1.00 (reference) | N.A |
Office worker | 2.52 | 1.38 (1.23–1.54) | 1.17 (1.04–1.31) | 0.95 | 1.45 (1.23–1.72) | ||
Farming/forestry | 2.05 | 1.12 (1.02–1.24) | 0.95 (0.86–1.04) | 0.94 | 1.45 (1.26–1.66) | ||
Sales/industry/cleaning | 2.15 | 1.18 (1.08–1.27) | 1.04 (0.96–1.13) | 0.96 | 1.47 (1.31–1.66) | ||
Unknown | 3.27 | 1.79 (1.62–1.99) | 1.19 (1.06–1.32) | 1.48 | 2.30 (1.97–2.68) | ||
Did not respond | 2.50 | 1.36 (1.00–1.87) | 1.16 (0.85–1.58) | 0.25 | 0.38 (0.25–0.56) | ||
Hip replacement | No | 1.22 | 1.00 (reference) | 1.00 (reference) | 0.52 | 1.00 (reference) | 1.00 (reference) |
Yes | 41.83 | 42.0 (39.5–44.6) | 38.8 (36.5–41.2) | 36.47 | 94.3 (86.4–103.0) | 71.2 (65.1–77.9) | |
Knee replacement | No | 2.14 | 1.00 (reference) | 1.00 (reference) | 0.88 | 1.00 (reference) | 1.00 (reference) |
Yes | 59.15 | 28.4 (23.4–34.4) | 25.3 (20.8–30.7) | 36.84 | 45.9 (35.9–58.6) | 40.3 (31.5–51.5) | |
Cardiovascular disease | No | 2.18 | 1.00 (reference) | 1.00 (reference) | 0.83 | 1.00 (reference) | 1.00 (reference) |
Yes | 2.19 | 1.01 (0.95–1.06) | 0.94 (0.89–1.00) | 0.98 | 1.20 (1.11–1.30) | 0.99 (0.91–1.07) | |
Stroke | No | 2.18 | 1.00 (reference) | 1.00 (reference) | 0.86 | 1.00 (reference) | 1.00 (reference) |
Yes | 2.30 | 1.06 (0.96–1.17) | 1.05 (0.95–1.16) | 1.42 | 1.67 (1.47–1.89) | 1.42 (1.26–1.62) | |
Diabetes | No | 2.19 | 1.00 (reference) | 1.00 (reference) | 0.89 | 1.00 (reference) | 1.00 (reference) |
Yes | 2.14 | 0.98 (0.90–1.06) | 1.03 (0.95–1.13) | 0.99 | 1.11 (0.98–1.26) | 1.13 (0.99–1.28) | |
Cancer treatment | No | 2.19 | 1.00 (reference) | 1.00 (reference) | 0.90 | 1.00 (reference) | 1.00 (reference) |
Yes | 2.06 | 0.94 (0.71–1.24) | 1.01 (0.76–1.34) | 1.31 | 1.44 (1.05–1.98) | 1.67 (1.22–2.30) | |
Asthma/COPD | No | 2.18 | 1.00 (reference) | 1.00 (reference) | 0.90 | 1.00 (reference) | 1.00 (reference) |
Yes | 2.24 | 1.02 (0.93–1.13) | 1.03 (0.94–1.14) | 0.95 | 1.05 (0.91–1.21) | 1.07 (0.93–1.23) | |
Any mental or behavioural disorder | No | 2.09 | 1.00 (reference) | 1.00 (reference) | 0.85 | 1.00 (reference) | 1.00 (reference) |
Yes | 2.53 | 1.21 (1.14–1.29) | 1.16 (1.09–1.24) | 1.53 | 1.83 (1.63–2.05) | 1.71 (1.52–1.92) |
Risk factor | Category | AD cohort | Non-AD cohort | ||||
---|---|---|---|---|---|---|---|
IR/ 100 PY | Unadjusted HR (95% CI) | Adjusted HRa (95% CI) | IR/ 100 PY | Unadjusted HR HR (95% CI) | Adjusted HRa HR (95% CI) | ||
Any CVD medication | No | 2.21 | 1.00 (reference) | 1.00 (reference) | 0.63 | 1.00 (reference) | 1.00 (reference) |
Yes | 2.18 | 0.99 (0.91–1.06) | 0.84 (0.78–0.91) | 0.98 | 1.54 (1.37–1.73) | 1.02 (0.91–1.15) | |
Drugs for obstructive airway diseases | No | 2.21 | 1.00 (reference) | 1.00 (reference) | 0.90 | 1.00 (reference) | 1.00 (reference) |
Yes | 2.11 | 0.96 (0.89–1.02) | 0.97 (0.90–1.03) | 0.92 | 1.01 (0.92–1.11) | 1.00 (0.91–1.11) | |
Hormone therapy | No | 2.23 | 1.00 (reference) | 1.00 (reference) | 0.93 | 1.00 (reference) | 1.00 (reference) |
Yes | 1.66 | 0.74 (0.66–0.84) | 0.87 (0.77–0.98) | 0.51 | 0.54 (0.44–0.67) | 0.79 (0.64–0.98) | |
Bisphosphonates | No | 2.13 | 1.00 (reference) | 1.00 (reference) | 0.88 | 1.00 (reference) | 1.00 (reference) |
Yes | 2.58 | 1.21 (1.12–1.31) | 0.97 (0.90–1.05) | 1.14 | 1.29 (1.14–1.46) | 0.96 (0.85–1.08) | |
Proton pump inhibitors | No | 2.18 | 1.00 (reference) | 1.00 (reference) | 0.83 | 1.00 (reference) | 1.00 (reference) |
Yes | 2.19 | 1.00 (0.94–1.07) | 0.96 (0.90–1.02) | 1.07 | 1.27 (1.17–1.39) | 1.14 (1.05–1.25) | |
Anti-Parkinson drugs | No | 2.16 | 1.00 (reference) | 1.00 (reference) | 0.88 | 1.00 (reference) | 1.00 (reference) |
Yes | 2.95 | 1.36 (1.19–1.57) | 1.46 (1.27–1.68) | 1.66 | 1.86 (1.53–2.26) | 1.67 (1.38–2.03) | |
Antiepileptics drugs | No | 2.20 | 1.00 (reference) | 1.00 (reference) | 0.88 | 1.00 (reference) | 1.00 (reference) |
Yes | 2.09 | 0.95 (0.86–1.05) | 0.99 (0.90–1.09) | 1.23 | 1.37 (1.19–1.57) | 1.27 (1.11–1.46) | |
Antipsychotics | No | 2.12 | 1.00 (reference) | 1.00 (reference) | 0.85 | 1.00 (reference) | 1.00 (reference) |
Yes | 2.53 | 1.20 (1.11–1.29) | 1.12 (1.04–1.20) | 1.64 | 1.95 (1.73–2.20) | 1.56 (1.38–1.76) | |
Antidepressants | No | 2.14 | 1.00 (reference) | 1.00 (reference) | 0.83 | 1.00 (reference) | 1.00 (reference) |
Yes | 2.28 | 1.07 (1.00–1.13) | 1.06 (1.00–1.12) | 1.24 | 1.49 (1.36–1.64) | 1.34 (1.22–1.47) | |
BZDRS | No | 2.04 | 1.00 (reference) | 1.00 (reference) | 0.74 | 1.00 (reference) | 1.00 (reference) |
Yes | 2.39 | 1.17 (1.11–1.24) | 1.03 (0.97–1.09) | 1.18 | 1.58 (1.45–1.71) | 1.22 (1.12–1.32) | |
Opioids | No | 2.09 | 1.00 (reference) | 1.00 (reference) | 0.80 | 1.00 (reference) | 1.00 (reference) |
Yes | 2.34 | 1.12 (1.05–1.18) | 1.00 (0.94–1.06) | 1.12 | 1.36 (1.25–1.48) | 1.10 (1.01–1.19) |
Predictors of mortality after hip fracture
Risk factor | Category | AD cohort | Non-AD cohort | ||||
---|---|---|---|---|---|---|---|
Mortality/ 100 PY | Unadjusted HR (95% CI) | Adjusted HRa (95% CI) | Mortality/ 100 PY | Unadjusted HR (95% CI) | Adjusted HRa (95% CI) | ||
Age at baseline, increase per year | 1.04 (1.03–1.05) | 1.05 (1.05–1.06) | N.A | 1.07 (1.06–1.09) | 1.08 (1.07–1.10) | ||
Sex | Men | 25.1 | 1.00 (reference) | 1.00 (reference) | 19.4 | 1.00 (reference) | 1.00 (reference) |
Women | 47.7 | 1.90 (1.74–2.08) | 2.09 (1.90–2.29) | 39.3 | 2.06 (1.79–2.36) | 2.43 (2.10–2.80) | |
Highest occupational social class before follow-up | Managerial/professional | 29.9 | 1.00 (reference) | 1.00 (reference) | 23.4 | 1.00 (reference) | N.A |
Office worker | 25.6 | 0.85 (0.72–1.01) | 1.02 (0.86–1.21) | 20.7 | 0.88 (0.66–1.16) | ||
Farming/forestry | 30.6 | 1.02 (0.89–1.17) | 1.01 (0.88–1.15) | 23.0 | 0.97 (0.78–1.21) | ||
Sales/industry/cleaning | 29.6 | 0.99 (0.88–1.11) | 1.05 (0.93–1.18) | 23.7 | 1.00 (0.83–1.22) | ||
Unknown | 28.8 | 0.96 (0.83–1.12) | 1.04 (0.89–1.21) | 24.5 | 1.05 (0.82–1.34) | ||
Did not respond | 25.7 | 0.86 (0.55–1.33) | 1.03 (0.67–1.61) | 23.3 | 0.97 (0.48–1.98) | ||
Hip replacement | No | 29.36 | 1.00 (reference) | 1.00 (reference) | 23.38 | 1.00 (reference) | 1.00 (reference) |
Yes | 21.85 | 0.74 (0.49–1.13) | 0.68 (0.45–1.04) | 20.36 | 0.86 (0.46–1.61) | 1.22 (0.65–2.29) | |
Knee replacement | No | 29.62 | 1.00 (reference) | 1.00 (reference) | 23.47 | 1.00 (reference) | 1.00 (reference) |
Yes | 19.88 | 0.67 (0.52–0.87) | 0.73 (0.56–0.95) | 18.83 | 0.80 (0.51–1.24) | 0.88 (0.56–1.38) | |
Cardiovascular disease | No | 26.5 | 1.00 (reference) | 1.00 (reference) | 20.2 | 1.00 (reference) | 1.00 (reference) |
Yes | 32.1 | 1.21 (1.12–1.32) | 1.19 (1.10–1.29) | 26.0 | 1.28 (1.12–1.47) | 1.31 (1.15–1.50) | |
Stroke | No | 28.7 | 1.00 (reference) | 1.00 (reference) | 22.3 | 1.00 (reference) | 1.00 (reference) |
Yes | 36.8 | 1.28 (1.12–1.47) | 1.19 (1.03–1.37) | 37.9 | 1.70 (1.38–2.09) | 1.67 (1.35–2.06) | |
Diabetes | No | 28.7 | 1.00 (reference) | 1.00 (reference) | 23.3 | 1.00 (reference) | 1.00 (reference) |
Yes | 33.3 | 1.16 (1.03–1.31) | 1.22 (1.08–1.38) | 23.9 | 1.03 (0.85–1.24) | 1.17 (0.96–1.42) | |
Asthma/COPD | No | 28.9 | 1.00 (reference) | 1.00 (reference) | 23.5 | 1.00 (reference) | 1.00 (reference) |
Yes | 33.4 | 1.16 (1.01–1.33) | 1.17 (1.02–1.34) | 22.2 | 0.93 (0.74–1.17) | 1.04 (0.83–1.31) | |
Cancer treatment | No | 29.3 | 1.00 (reference) | 1.00 (reference) | 23.3 | 1.00 (reference) | 1.00 (reference) |
Yes | 23.6 | 0.81 (0.52–1.24) | 0.88 (0.57–1.35) | 26.4 | 1.12 (0.68–1.83) | 1.63 (0.99–2.68) | |
Any mental or behavioural disorder | No | 28.2 | 1.00 (reference) | 1.00 (reference) | 22.8 | 1.00 (reference) | 1.00 (reference) |
Yes | 31.6 | 1.12 (1.03–1.22) | 1.18 (1.08–1.29) | 28.1 | 1.25 (1.02–1.54) | 1.28 (1.04–1.58) |
Risk factor | Category | AD cohort | Non-AD cohort | ||||
---|---|---|---|---|---|---|---|
Mortality/ 100 PY | Unadjusted HR (95% CI) | Adjusted HRa (95% CI) | Mortality/ 100 PY | Unadjusted HR (95% CI) | Adjusted HRa (95% CI) | ||
Any CVD medication | Yes | 31.6 | 1.12 (1.03–1.22) | 1.18 (1.08–1.29) | 28.1 | 1.25 (1.02–1.54) | 1.28 (1.04–1.58) |
No | 24.7 | 1.00 (reference) | 1.00 (reference) | 17.4 | 1.00 (reference) | 1.00 (reference) | |
Yes | 30.0 | 1.17 (1.05–1.31) | 1.17 (1.04–1.31) | 24.0 | 1.36 (1.06–1.74) | 1.37 (1.07–1.76) | |
Drugs for obstructive airway diseases | No | 28.3 | 1.00 (reference) | 1.00 (reference) | 23.1 | 1.00 (reference) | 1.00 (reference) |
Yes | 35.3 | 1.25 (1.12–1.39) | 1.17 (1.05–1.30) | 24.3 | 1.04 (0.88–1.23) | 1.11 (0.94–1.32) | |
Hormone therapy | No | 29.8 | 1.00 (reference) | 1.00 (reference) | 23.7 | 1.00 (reference) | 1.00 (reference) |
Yes | 18.6 | 0.63 (0.49–0.80) | 0.81 (0.64–1.04) | 11.7 | 0.50 (0.29–0.85) | 0.78 (0.46–1.32) | |
Bisphosphonates | No | 29.5 | 1.00 (reference) | 1.00 (reference) | 23.7 | 1.00 (reference) | 1.00 (reference) |
Yes | 28.1 | 0.95 (0.85–1.07) | 1.07 (0.95–1.20) | 21.0 | 0.88 (0.72–1.06) | 1.06 (0.87–1.29) | |
Proton pump inhibitors | No | 26.8 | 1.00 (reference) | 1.00 (reference) | 21.0 | 1.00 (reference) | 1.00 (reference) |
Yes | 33.4 | 1.24 (1.15–1.35) | 1.25 (1.15–1.36) | 26.8 | 1.27 (1.12–1.45) | 1.31 (1.15–1.49) | |
Anti–Parkinson drugs | No | 29.28 | 1.00 (reference) | 1.00 (reference) | 23.12 | 1.00 (reference) | 1.00 (reference) |
Yes | 29.10 | 0.99 (0.84–1.18) | 1.02 (0.86–1.21) | 27.15 | 1.18 (0.91–1.54) | 1.20 (0.92–1.56) | |
Antiepileptics drugs | No | 29.0 | 1.00 (reference) | 1.00 (reference) | 23.6 | 1.00 (reference) | 1.00 (reference) |
Yes | 31.9 | 1.10 (0.96–1.25) | 1.12 (0.99–1.28) | 21.2 | 0.90 (0.72–1.11) | 0.98 (0.79–1.21) | |
Antipsychotics | No | 28.2 | 1.00 (reference) | 1.00 (reference) | 22.3 | 1.00 (reference) | 1.00 (reference) |
Yes | 31.1 | 1.10 (1.01–1.20) | 1.16 (1.06–1.26) | 30.9 | 1.41 (1.18–1.68) | 1.41 (1.18–1.68) | |
Antidepressants | No | 30.7 | 1.00 (reference) | 1.00 (reference) | 22.1 | 1.00 (reference) | 1.00 (reference) |
Yes | 27.5 | 0.89 (0.82–0.97) | 0.97 (0.89–1.05) | 26.9 | 1.22 (1.05–1.40) | 1.29 (1.11–1.48) | |
BZDRS | No | 28.4 | 1.00 (reference) | 1.00 (reference) | 21.3 | 1.00 (reference) | 1.00 (reference) |
Yes | 30.2 | 1.06 (0.98–1.15) | 1.06 (0.98–1.15) | 25.7 | 1.21 (1.06–1.38) | 1.18 (1.04–1.35) | |
Opioids | No | 25.5 | 1.00 (reference) | 1.00 (reference) | 18.7 | 1.00 (reference) | 1.00 (reference) |
Yes | 32.9 | 1.30 (1.20–1.41) | 1.29 (1.19–1.40) | 28.5 | 1.50 (1.31–1.72) | 1.56 (1.36–1.79) |