# Orthogeriatric co-management of fragility fractures: a retrospective cohort study on one-year mortality and functional outcomes across fracture types

## TL;DR

This study examines mortality and recovery outcomes for older adults with various fragility fractures under orthogeriatric care, finding high mortality and significant functional decline.

## Contribution

The study provides novel evidence on one-year mortality and functional outcomes for multiple fragility fracture types under structured orthogeriatric co-management.

## Key findings

- One-year mortality was 32.3%, with periprosthetic femoral fractures having the highest mortality (42.3%) and pelvic ring fractures the lowest (18.4%).
- Discharge home was strongly correlated with better survival compared to discharge to a nursing home.
- Only 52.3% of previously independent patients maintained independence after one year.

## Abstract

Fragility fractures in older adults are associated with high morbidity and mortality, yet evidence beyond hip fractures remains limited. This study analysed one‑year mortality and functional outcomes across multiple fracture types managed under structured orthogeriatric co‑management in a certified Geriatric Trauma Centre.

We retrospectively reviewed 486 patients aged ≥ 70 years (mean 83.8 ± 6.6; 70.2% female) with fragility fractures (proximal and periprosthetic femur, cervical and thoracolumbar spine, pelvic ring, proximal humerus) treated between 2019 and 2021. All patients were screened using the Identification of Seniors at Risk (ISAR) and received interdisciplinary orthogeriatric care. Mortality and residential status at one year were ascertained via the national citizen registry, ensuring complete follow-up. Primary endpoints were one‑year mortality and residential status. Logistic regression identified predictors of survival.

Overall, one‑year mortality was 32.3%, highest for periprosthetic femoral (42.3%) and lowest for pelvic ring fractures (18.4%). Pelvic ring fractures independently predicted improved survival (OR 3.46; p = 0.006), while Charlson Comorbidity Index > 6 predicted higher mortality (OR 0.44; p = 0.001). Only 52.3% of previously independent patients maintained independent living after one year. Discharge home strongly correlated with survival (mortality 12.9% vs. 39.6% after nursing home discharge; p = 0.003).

Fragility fractures of all types carry high one‑year mortality and substantial functional decline. Discharge destination is a powerful prognostic marker and should inform early rehabilitation planning. Orthogeriatric strategies must extend beyond hip fractures and integrate frailty assessment to identify orthogeriatric responders likely to regain independence.