IN RESPONSE:
I would like to thank Dr. Galus for bringing up the important issue of increased mortality in patients with osteoporotic fractures. In an epidemiologic study based on the geographically defined population of Rochester, Minnesota, Cooper and associates [1] found a significant reduction in relative 5-year survival of about 20% in patients with hip and vertebral fracture but not patients with Colles fracture of the distal forearm. The patients with vertebral fracture showed a progressive increase in excess mortality over 5 years, whereas the excess mortality in patients with hip fracture occurred largely in the first 6 months after the fracture. Increased mortality has also been reported after pelvic fractures in older women [2]. Death after hip fracture in both men and women [2, 3] not only is associated with complications after surgery but is also influenced by comorbid conditions. The relation between osteoporosis and comorbid conditions is complex; for example, decreased bone density is associated with an increased risk for stroke [4] and a decreased risk for breast cancer [5]. An understanding of these complex interactions may help us understand the association between osteoporosis and death, but the fact remains that osteoporosis will rarely be recorded as the cause of death on a death certificate. Moreover, although we do not know whether treatment of osteoporosis will reduce this excess mortality, I believe that conscientious physicians like Dr. Galus, who identify and treat osteoporotic patients, will have an important impact on mortality as well as morbidity in our aging population.
1. Cooper C, Atkinson EJ, Jacobsen SJ, O'Fallon WM, Melton LJ III. Population-based study of survival after osteoporotic fractures. Am J Epidemiol. 1993; 137:1001.
2. Browner WS, Pressman AR, Nevitt MC, Cummings SR. Mortality following fractures in older women. The study of osteoporotic fractures. Arch Intern Med. 1996; 156:1521-5.
3. Poor G, Atkinson EJ, O'Fallon WM, Melton LJ III. Determinants of reduced survival following hip fractures in men. Clin Orthop Rel Res. 1995; 319:260-5.
4. Browner WS, Pressman AR, Nevitt MC, Cauley JA, Cummings SR. Association between low bone density and stroke in elderly women. The study of osteoporotic fractures. Stroke. 1993; 24:940-6.
5. Cauley JA, Lucas FL, Kuller LH, Vogt MT, Browner WS, Cummings SR. Bone mineral density and risk of breast cancer in older women-the study of osteoporotic fractures. JAMA. 1996; 276:1404-8.
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