Mortality After Lower Extremity Fractures in Men With Spinal Cord Injury

ABSTRACT In the United States, there are over 200,000 men with spinal cord injuries (SCIs) who are at risk for lower limb fractures. The risk of mortality after fractures in SCI is unknown. This was a population‐based, cohort study of all male veterans (mean age 54.1; range, 20.3–100.5 years) with a traumatic SCI of at least 2 years' duration enrolled in the Veterans Affairs (VA) Spinal Cord Dysfunction Registry from FY2002 to FY2010 to determine the association between lower extremity fractures and mortality. Mortality for up to 5 years was determined. The lower extremity fracture rate was 2.14 per 100 patient‐years at risk for at least one fracture. In unadjusted models and in models adjusted for demographic, SCI‐related factors, healthcare use, and comorbidities, there was a significant association between incident lower extremity fracture and increased mortality (hazard ratio [HR], 1.38; 95% confidence interval [CI], 1.17–1.63; HR, 1.36; 95% CI, 1.15–1.61, respectively). In complete SCI, the hazard of death after lower extremity fracture was also increased (unadjusted model: HR, 1.46; 95% CI, 1.13–1.89; adjusted model: HR, 1.32; 95% CI, 1.02–1.71). In fully‐adjusted models, the association of incident lower extremity fracture with increased mortality was substantially greater in older men (age ≥50 years) for the entire cohort (HR, 3.42; 95% CI, 2.75–4.25) and for those with complete SCI (HR, 3.13; 95% CI, 2.19–4.45), compared to younger men (age