Impact of the Blue Zone Lifestyle on Vertebral Compression Fracture Mortality: A Retrospective Cohort Analysis.

BACKGROUND

Vertebral compression fractures (VCFs) are common fragility fractures and are associated with significant mortality and healthcare costs. "Blue Zones," regions with high longevity and low chronic disease rates, offer a unique opportunity to study how lifestyle factors influence fracture outcomes.

METHODS

A retrospective cohort review of conservatively treated fragility VCFs diagnosed within emergency department encounters from January 2013 to December 2022 was conducted at a single tertiary care institution in the Blue Zone. Key variables collected include demographics, health metrics, and chronic medical conditions. Mortality was assessed through electronic medical records and public records (Google, Instant Checkmate database). 1:1 Propensity score matching (PSM) was used to minimize bias.

RESULTS

The retrospective cohort review resulted in 105 Blue Zone and 544 non-Blue Zone patients. Before PSM, the average age at diagnosis of VCF in the Blue Zone was 76±13 years compared to 66±12 years (P<0.001) in non-Blue Zone patients. After 1:1 PSM, Blue Zone patients had equal mortality rates at 1 year post-diagnosis (6.6% vs. 5.7%, P=0.159) and 2-years post-diagnosis (14% vs. 11%, 0.507).

CONCLUSION

Patients living within the Blue Zone sustained fragility vertebral compression fractures nearly 10 years later when compared to non-Blue Zone patients. Importantly, this association is observational in nature and does not imply a causal relationship between Blue Zone residence or lifestyle factors and delayed fracture onset. This finding highlights the potential benefits of adopting Blue Zone lifestyle principles to improve overall health and delay age-related conditions.