Evidence map›Paper›PMID 40208326›Full record

ArticleOsteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA2025

Excess subsequent fracture and mortality risk after ankle fractures: a relative survival analysis of the 45 and Up Study.

Weiwen Chen, Lyn M March, Fiona M Blyth, Dunia Alarkawi, Robert D Blank, Dana Bliuc, Thach Tran, Jacqueline R Center

Abstract read
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In one paragraph

Article in Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

2 citing papers in PubMed.

  1. Article
  2. Author response to letter to the editor to ankle fractures: A pragmatic opportunity for osteoporosis case finding (OSIN-D-25-01889).Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA · 2025
    Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors.

Weiwen ChenGarvan Institute of Medical Research, Sydney, NSW, Australia. w.chen@garvan.org.au.ORCID http://orcid.org/0000-0003-4940-7445
Lyn M MarchSydney Medical School, University of Sydney, Sydney, NSW, Australia.
Fiona M BlythSydney Medical School, University of Sydney, Sydney, NSW, Australia.
Dunia AlarkawiGarvan Institute of Medical Research, Sydney, NSW, Australia.
Robert D BlankGarvan Institute of Medical Research, Sydney, NSW, Australia.
Dana BliucGarvan Institute of Medical Research, Sydney, NSW, Australia.
Thach TranGarvan Institute of Medical Research, Sydney, NSW, Australia.
Jacqueline R CenterGarvan Institute of Medical Research, Sydney, NSW, Australia.

Funding

National Health and Medical Research Council APP1075053
6 · The paper itself

Abstract

Ankle fractures are one of the common fractures that account for hospitalization. Ankle fractures were often thought of inconsequential as limited data on their long-term consequences. After accounting for age, sex, and time, ankle fractures were associated with increased risk of subsequent fracture and mortality.

backgroundAnkle fractures are common but it is uncertain whether they are indicative of poor bone health. There are limited data about subsequent fracture and mortality risk following ankle fractures.

objectiveTo determine if there is increased subsequent fracture and mortality risk after ankle fractures.

methodsA prospective population-based cohort of 143,070 women and 123,818 men in the 45 and Up Study (NSW, Australia) had baseline questionnaire responses that were linked to Emergency Department Data Collection (EDDC), the Admitted Patient Data Collection (APDC), and the NSW Registry of Births Deaths & Marriages death registrations from 2006 to 2017. Secure data access was provided through the Sax Institute's Secure Unified Research Environment (SURE). Sex-specific excess risks of subsequent fracture and mortality following ankle fractures were quantified using relative survival analysis.

resultsDuring 1,490,651 person-years, women and men experienced 1379 and 579 ankle fractures and 78 deaths and 76 deaths, respectively. Ankle fractures were associated with a 5-year 5% (95% CI 3-8%) excess risk of subsequent fracture in both women and men, compared to subjects' risk of an incident fracture in the study. There was a 5-year cumulative excess mortality of 10% (95% CI 6-13%) following ankle fractures in men but no excess mortality in women compared to the overall cohort. Participants with ankle fractures who died were older (P < 0.001), more likely to have had a second fracture (P < 0.001), have had a prior fracture (P < 0.001), and have more comorbidities (P < 0.001).

conclusionIn the 45 and Up cohort, there was a modest but significant increased risk of fracture following ankle fracture seen in both women and men. In men, but not women, ankle fractures were associated with 10% excess mortality. Ankle fractures should be considered for secondary fracture prevention in those who are older and have more comorbidities.

Indexed as

Ankle FracturesOsteoporotic FracturesAdultAgedAged, 80 and overFemaleFollow-Up StudiesHumansMaleMiddle AgedNew South WalesProspective StudiesRisk AssessmentRisk FactorsSex DistributionSex FactorsAnkle fractureMortality riskOutcomesRelative survival analysisSubsequent fracture risk

Identifiers

PMID40208326

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.