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BMJ 2010; 340 doi: (Published 24 March 2010) Cite this as: BMJ 2010;340:c1599

High mortality persists for years after a hip fracture

Mortality is high for the first few months after a hip fracture. One meta-analysis reported a hazard ratio for all cause death during the first three months of 5.75 (95% CI 4.94 to 6.67) for women and 7.95 (6.13 to 10.30) for men, relative to adults of the same age without hip fracture. Excess risk fell sharply during the next two years, but never made it to zero. Annual mortality remained higher than normal for up to 15 years after a fracture (relative hazard after 15 years 3.00 (1.10 to 8.18) for women and 3.52 (0.99 to 12.5) for men).

The authors pooled data from 24 published studies of survival after hip fracture—22 separate cohorts of women and 17 cohorts of men. The studies were heterogeneous and had other limitations including a variety of populations, control groups, and adjustments for confounding. Even so, the authors are fairly confident that the enduring risk after hip fracture is real, and a new finding. What they can’t confirm is that hip fracture is directly responsible for the extra deaths long term. People who sustain fractures are generally more frail than those who don’t. Differences in comorbidities before the injury could explain at least some of the excess deaths. In this analysis, men had higher mortality than women at all ages.

Cancer isn’t beaten yet, but neither are we

Cancer is a complex biological phenomenon made up of more than 100 anatomical subtypes, many of which are further divided into variants with differing histology, prognosis, and response to treatment. Like viruses, cancers can be hard to pin down as they mutate and clone, developing resistance and other effective defences against treatment. Meanwhile, close to half of all men and a third of all women will experience cancer at some point in their lives. So, are we losing the battle against …

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