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AFTER THE FALL

A staggering death toll, but limited attention

Extensive research and aggressive treatment are reducing the death toll from stroke, cancer, and many other diseases. Hip fracture is a different story.

The troubling increase in the death rate in hip fracture patients -- from 24 percent in the 1980s to 29 percent in the new Globe study -- demands an aggressive response, some researchers said. Hip fractures far too often start a cascade of complications that ends in death.

"It's a huge rate and it isn't going down," said Vincent Mor, chairman of the department of community health at Brown University. "It's time to take a look at hip fracture the same way we've looked at heart disease and find out what we can do to ameliorate the death rate."

Some of the increase may be explained by the aging of the population, since older patients are frailer. But researchers say the stubbornly high death rate remains a puzzle.

There has been comparatively little research on broken hips. In 2005, the National Institutes of Health funded more than 1,200 studies on stroke but fewer than 50 on hip fractures.

The nation is spending as much as $15 billion a year to treat patients with hip fractures. And it's spending millions more to prevent osteoporosis, which may be helping to temporarily reduce the number of hip fractures.

"The emphasis has been more on preventing the fractures than on treating them," said University of Maryland professor Jay Magaziner, who leads the Baltimore Hip Studies on improving recovery and who oversaw the death-rate study for the Globe.

The study, conducted by research fellow Ajith Silva , used Medicare records to track deaths after more than 600,000 hip fracture surgeries in 2000-2002. The records show when patients died but not the specific cause of death.

Many patients die from heart problems or infections aggravated by the hip fracture. But the death rate was also high -- 23 percent -- among patients with no serious illnesses when they broke their hip.

The study also underscores the apparent link between America's aging population and the increase in fracture deaths. Thirty-six percent of those 85 and older die within a year of a break compared with 19 percent of those 65 to 74. In addition, more men than ever are breaking their hips and hip fracture is more deadly for men.

The Globe found that 39 percent of men die within a year compared with 26 percent of women. Men may be more likely to die because they are typically sicker when they break their hips. In addition, another study by Magaziner and his colleagues found that men got more deadly infections -- such as pneumonia, flu, or blood poisoning -- after a fracture.

Magaziner hypothesized that fractures do long-term damage to the immune system, with men being particularly vulnerable for unknown reasons.

"Some of the deaths could be prevented," Magaziner said.

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