Excess mortality up to 7 years after low-trauma hip fracture in the largest urban region in Romania

Hip fracture is the most severe complication of osteoporosis. We followed up patients with hip fracture for up to 7 years. Compared with the general population, the overall mortality rate ratio was approximately 9.27 over the follow-up period. Our findings justify the need for urgent improvement of osteoporosis and hip-fracture care. INTRODUCTION: Hip fracture is the most severe complication of osteoporosis, being associated with substantial morbidity, loss of independence, and increased long-term mortality. Data on excess mortality after hip fracture in the population from Eastern Europe is very limited. The objective of the study is to quantify excess mortality after hip fracture by comparing observed with expected mortality derived from age-specific population data for the largest urban region in Romania. METHODS: We performed a longitudinal observational cohort study including patients hospitalized with hip fracture followed longitudinally up to 7 years after the fracture. RESULTS: A total of 1977 hip fracture patients (1452 women) aged ≥ 40 years were included. Between 2018 and 2024, 1460 deaths occurred (overall mortality 73.85); the overall crude mortality rate in the cohort was 215.6 per 1000 person-years. Compared with the general population, the overall age-specific mortality rate ratio (RR) was approximately 9.27 over the follow-up period. Cohort crude mortality rates were highest in the first post-fracture year and then decreased but remained elevated all across follow-up with overall annual cohort-to-population RRs of 5.74 to 18.10. In univariate Cox regression analyses, female sex was associated with a lower risk of mortality (HR 0.84, 95% CI 0.75-0.94, p = 0.002), while conservative management was associated with a markedly increased risk of death compared with surgical treatment (HR 1.95, 95% CI 1.72-2.21, p < 0.001). In multivariate Cox proportional hazards analysis, conservative management remained independently associated with an increased risk of all-cause mortality (HR 2.01, 95% CI 1.77-2.28, p < 0.001), female sex remains independently associated with improved survival (HR 0.67, 95% CI 0.60-0.76, p < 0.001), and also increasing age is a strong independent predictor of mortality (HR 1.33, 95% CI 1.28-1.37, p < 0.001). CONCLUSIONS: Hip fracture is associated with a high and lasting mortality burden in Romanian patients. These findings justify the need for urgent improvement of osteoporosis care and hip fracture systems, aiming to improve survival and quality of life for this patient population.