Background: Ankle fractures are common but are often not considered to be osteoporotic fractures as they occur in patients with higher bone density.
Objectives: To examine the risk of subsequent fracture and mortality following ankle fractures
Methods: Baseline questionnaire data from the 45 and Up Study (143,070 women and 128,818 men) were linked to the Emergency Department Data Collection (EDDC), Admitted Patient Data Collection (ADPC), Registry of Births, Marriages and Death (RBDM). Fractures were identified from the EDDC and ADPC using the ICD 9, 10, SNOMED and procedure codes. Participants were followed from recruitment (2005-2009) until death or 1/4/2017. Relative survival analysis and Cox proportional hazards regression with fracture as a time-dependent variable were used to quantify the contribution of ankle fracture to subsequent fracture and mortality, respectively.
Results: During a mean follow-up of 8.4± 1.9 years, 1,579 women and 519 men sustained an ankle fracture. Participants who experienced ankle fractures were younger, had higher body weight and fewer co-morbidities than those who experienced other fractures. Ankle fracture patients sustained a subsequent fracture after an average of 2.6± 2.1 years. Following ankle fracture, there was a 5% increased risk of a subsequent fracture in both sexes compared to the overall initial fracture risk. Proximal fractures accounted for 56% of the subsequent fractures Ankle fractures were associated with increased mortality in men (HR: 1.34; 95% CI: 1.02-1.77). Similar trend was seen in women but did not reach significance (HR: 1.10; 95% CI: 0.85-1.42). The presence of diabetes and a subsequent proximal fracture were predictive of the increased mortality in men.
Conclusion: In this healthy cohort, ankle fractures were associated with a modestly increased risk of further fractures and increased mortality in men. Ankle fractures should be considered as an indication for fracture prevention.