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Advanced Age, High β-CTX Levels, and Impaired Renal Function are Independent Risk Factors for All-Cause One-Year Mortality in Hip Fracture Patients

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Abstract

Risk factors for increased mortality in hip fracture patients include older age, male sex, fracture type, bone mineral density, and pre-existing co-morbidities. The role of biochemical and other anthropometric parameters on hip fracture mortality remains unclear. The aim of this study was to identify the risk factors for one-year mortality in patients with hip fractures. A total of 236 consecutive patients (59 males) with hip fractures were followed over a one-year period. Patient age, gender, type of fracture, type of treatment, time from admission to surgery, type of anesthesia, body mass index, and electrocardiograms were recorded. Complete blood counts, serum electrolytes, urea, creatinine, d-dimers, calcium, phosphate, osteocalcin, and beta-isomerised C-terminal telopeptide of collagen type I (β-CTX) were measured at admission and estimated glomerular filtration rate (eGFR) was calculated. Multivariate Cox regression models were used to analyze the association of these parameters with survival. One-year mortality rate was 28.4 %. Age was independently associated with mortality (HR 1.117, 95 % CI 1.062–1.174, P < 0.001). In a multivariable model, mortality was increased in patients with higher β-CTX (HR 4.63 95 % CI 1.87–11.45, P = 0.001) and lower eGFR (HR 0.972, 95 % CI 0.956–0.987, P < 0.001). Patients younger than 84 years, with eGFR < 55.4 ml/min had ten times higher mortality rates (3.2 vs. 24.5 %, HR 9.73, 95 % CI 2.06–45.93) as well as those with β-CTX > 0.276 g/L (3.5 vs. 25.7 %, HR 9.5, 95 % CI 2.11–42.76). Advanced age, high β-CTX levels, and impaired renal function are independent risk factors of mortality in patients with hip fractures.

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Authors and Affiliations

  1. Department of Nephrology and Dialysis, University Hospital Center “Sestre Milosrdnice”, University of Zagreb Medical School, 10000, Zagreb, Croatia

    Tonko Gulin

  2. Department of Endocrinology, Diabetes and Metabolic Diseases “Mladen Sekso”, University Hospital Center “Sestre Milosrdnice”, University of Zagreb Medical School, Vinogradska cesta 29, 10000, Zagreb, Croatia

    Ivan Kruljac & Lora Kirigin

  3. Department of Pulmonology, Immunology and Rheumatology, University Hospital Center “Sestre Milosrdnice”, 10000, Zagreb, Croatia

    Marcela Merc

  4. Clinical Institute of Chemistry, University Hospital Center “Sestre Milosrdnice”, University of Zagreb Medical School, 10000, Zagreb, Croatia

    Marina Pavić

  5. Tissue Bank, University Hospital Center “Sestre Milosrdnice”, 10000, Zagreb, Croatia

    Mirna Tominac Trcin

  6. Laboratory of Endocrinology, Department of Oncology and Nuclear Medicine, University Hospital Center “Sestre Milosrdnice”, University of Zagreb Medical School, 10000, Zagreb, Croatia

    Adrijana Bokulić & Željka Bukovec Megla

  7. Department of Endocrinology, University Hospital Center Zagreb, University of Zagreb Medical School, 10000, Zagreb, Croatia

    Darko Kaštelan

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  1. Tonko Gulin
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Correspondence to Ivan Kruljac.

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Conflicts of Interest

Tonko Gulin, Ivan Kruljac, Lora Kirigin, Marcela Merc, Marina Pavić, Mirna Tominac Trcin, Adrijana Bokulić, Željka Bukovec Megla, and Darko Kaštelan declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000. Informed consent was obtained from all patients for being included in the study.

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Gulin, T., Kruljac, I., Kirigin, L. et al. Advanced Age, High β-CTX Levels, and Impaired Renal Function are Independent Risk Factors for All-Cause One-Year Mortality in Hip Fracture Patients. Calcif Tissue Int 98, 67–75 (2016). https://doi.org/10.1007/s00223-015-0070-x

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