{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T06:13:23Z","timestamp":1792131203475,"version":"4.4.0"},"reference-count":15,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2025,10,31]],"date-time":"2025-10-31T00:00:00Z","timestamp":1761868800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,10,31]],"date-time":"2025-10-31T00:00:00Z","timestamp":1761868800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Sci Rep"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Fragility pelvic fractures (FPF) are increasingly common among elderly patients and, despite being caused by low-energy mechanisms, can result in major arterial bleeding (MAB). However, few studies have examined the prevalence and predictors of MAB in this population. This study aimed to evaluate prevalence and potential risk factors associated with MAB in elderly patients with FPF. This retrospective cohort study used data from the Japan Trauma Data Bank. The study included patients (age\u2009\u2267\u200965 years) with FPF between 2010 and 2021, defining FPF as pelvic fractures caused by a ground-level fall. Demographic, comorbidities, and antithrombotic use were analyzed. MAB was operationally defined by the performance of therapeutic angioembolization (TAE). Multivariable logistic regression was performed to identify predictors of MAB and in-hospital mortality. A total of 1,354 patients met inclusion criteria; 80 patients (5.9%) underwent TAE. Compared with the non-MAB group, the MAB group had significantly higher rates of liver disease, cerebral vascular disease, use of antithrombotic agents, systolic blood pressure (SBP)\u2009&lt;\u200990 mmHg, and lower Glasgow Coma Scale scores. A multivariable logistic regression analysis revealed that age (OR 1.04, 95% CI 1.01\u20131.07), male sex (OR 2.42, 95% CI 1.49\u20133.93), cerebral vascular disease (OR 2.11, 95% CI 1.21\u20133.67), liver disease (OR 6.23, 95% CI 2.36\u201316.40), and SBP\u2009&lt;\u200990 mmHg (OR 5.43, 95% CI 2.96\u20139.97) were independently associated with MAB. MAB itself was independently associated with higher in-hospital mortality (OR 4.3, 95% CI 2.1\u20138.9). Notably, 28% of in-hospital deaths occurred within 48\u00a0h and 50% within 7 days of admission. Despite their low-energy origin, FPFs can lead to life-threatening hemorrhage requiring invasive hemostatic intervention. A subset of elderly patients\u2014particularly those with comorbidities or hypotension upon admission\u2014are at elevated risk of MAB and poor outcomes. Early recognition and targeted intervention strategies are essential to improve survival in this growing and vulnerable population.<\/jats:p>","DOI":"10.1038\/s41598-025-22076-1","type":"journal-article","created":{"date-parts":[[2025,10,31]],"date-time":"2025-10-31T12:58:33Z","timestamp":1761915513000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Prevalence and risk factors for major arterial bleeding in fragility pelvic fractures in the aging population"],"prefix":"10.1038","volume":"15","author":[{"given":"Shokei","family":"Matsumoto","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Makoto","family":"Aoki","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masayuki","family":"Shimizu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,10,31]]},"reference":[{"key":"22076_CR1","doi-asserted-by":"publisher","first-page":"465","DOI":"10.1359\/jbmr.061113","volume":"22","author":"R Burge","year":"2009","unstructured":"Burge, R. et al. Incidence and economic burden of Osteoporosis-Related fractures in the united States, 2005\u20132025*. J. Bone Min. Res. 22, 465\u2013475 (2009).","journal-title":"J. Bone Min. Res."},{"key":"22076_CR2","doi-asserted-by":"publisher","first-page":"577","DOI":"10.1007\/s00223-015-0056-8","volume":"97","author":"P Kannus","year":"2015","unstructured":"Kannus, P., Parkkari, J., Niemi, S. & Siev\u00e4nen, H. Low-Trauma pelvic fractures in elderly Finns in 1970\u20132013. Calcif Tissue Int. 97, 577\u2013580 (2015).","journal-title":"Calcif Tissue Int."},{"key":"22076_CR3","doi-asserted-by":"publisher","first-page":"669","DOI":"10.1186\/s12877-022-03223-z","volume":"22","author":"M Ramser","year":"2022","unstructured":"Ramser, M. et al. The impact of specific fracture characteristics of low-energy fractures of the pelvis on mortality. BMC Geriatr. 22, 669 (2022).","journal-title":"BMC Geriatr."},{"key":"22076_CR4","doi-asserted-by":"publisher","first-page":"315","DOI":"10.1186\/s12877-019-1320-y","volume":"19","author":"A Reito","year":"2019","unstructured":"Reito, A. et al. Mortality and comorbidity after non-operatively managed, low-energy pelvic fracture in patients over age 70: a comparison with an age-matched femoral neck fracture cohort and general population. BMC Geriatr. 19, 315 (2019).","journal-title":"BMC Geriatr."},{"key":"22076_CR5","doi-asserted-by":"publisher","first-page":"363","DOI":"10.1007\/s00068-014-0452-1","volume":"41","author":"SO Dietz","year":"2015","unstructured":"Dietz, S. O., Hofmann, A. & Rommens, P. M. Haemorrhage in fragility fractures of the pelvis. Eur. J. Trauma. Emerg. Surg. 41, 363\u2013367 (2015).","journal-title":"Eur. J. Trauma. Emerg. Surg."},{"key":"22076_CR6","doi-asserted-by":"publisher","first-page":"163","DOI":"10.1177\/2151458516649642","volume":"7","author":"CD Weber","year":"2016","unstructured":"Weber, C. D. et al. Management of Life-Threatening arterial hemorrhage following a fragility fracture of the pelvis in the anticoagulated patient: case report and review of the literature. Geriatr. Orthop. Surg. Rehabil. 7, 163\u2013167 (2016).","journal-title":"Geriatr. Orthop. Surg. Rehabil"},{"key":"22076_CR7","doi-asserted-by":"publisher","first-page":"437","DOI":"10.1097\/TA.0b013e31822ad41f","volume":"72","author":"D Krappinger","year":"2012","unstructured":"Krappinger, D. et al. Hemorrhage after low-energy pelvic trauma. J. Trauma. Acute Care Surg. 72, 437\u2013442 (2012).","journal-title":"J. Trauma. Acute Care Surg."},{"key":"22076_CR8","doi-asserted-by":"publisher","first-page":"5","DOI":"10.1186\/s13017-017-0117-6","volume":"12","author":"F Coccolini","year":"2017","unstructured":"Coccolini, F. et al. Pelvic trauma: WSES classification and guidelines. World J. Emerg. Surg. 12, 5 (2017).","journal-title":"World J. Emerg. Surg."},{"key":"22076_CR9","doi-asserted-by":"publisher","first-page":"2229","DOI":"10.1007\/s00268-020-05441-1","volume":"44","author":"S Matsumoto","year":"2020","unstructured":"Matsumoto, S. et al. Effectiveness and usage trends of hemorrhage control interventions in patients with pelvic fracture in shock. World J. Surg. 44, 2229\u20132236 (2020).","journal-title":"World J. Surg."},{"key":"22076_CR10","first-page":"1850","volume":"71","author":"DC Cullinane","year":"2011","unstructured":"Cullinane, D. C. et al. Eastern association for the surgery of trauma practice management guidelines for hemorrhage in pelvic fracture\u2013update and systematic review. J. Trauma. 71, 1850\u20131868 (2011).","journal-title":"J. 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