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Osteoporos Int. 2019 May 31. doi: 10.1007/s00198-019-05017-3. [Epub ahead of print]

Five-year refracture rates of a province-wide fracture liaison service.

Author information

1
Musculoskeletal Health and Outcomes Research, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, ON, Canada. sujicr@smh.ca.
2
Musculoskeletal Health and Outcomes Research, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, ON, Canada.
3
Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.
4
Institute for Work & Health, Toronto, ON, Canada.
5
Li Ka Shing Centre for Healthcare Analytics Research & Training, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, ON, Canada.
6
Institute for Clinical Evaluative Sciences, Toronto, ON, Canada.
7
Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada.
8
Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
9
Toronto Rehabilitation Institute - University Health Network, Toronto, ON, Canada.
10
Department of Physical Therapy, University of Toronto, Toronto, ON, Canada.
11
Ontario Osteoporosis Strategy, Osteoporosis Canada, Toronto, ON, Canada.
12
Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada.
13
Mobility Program, St. Michael's Hospital, Toronto, ON, Canada.

Abstract

We examined the 5-year refracture rate of 6543 patients and found an overall rate of 9.7%. Adjusted analysis showed that presenting with multiple fractures was an indicator of a higher refracture risk; while presenting with an ankle fracture was associated with a lower refracture risk.

INTRODUCTION:

To examine refractures among patients screened in a province-wide fracture liaison service (FLS).

METHODS:

We assessed the 5-year refracture rate of fragility fracture patients aged 50+ who were screened at 37 FLS fracture clinics in Ontario, Canada. Refracture was defined as a new hip, pelvis, spine, distal radius, or proximal humerus fracture. Kaplan-Meier curves and Cox proportional hazards model adjusting for age, sex, and index fracture type were used to examine refracture rates.

RESULTS:

The 5-year refracture rate of 6543 patients was 9.7%. Those presenting with multiple fractures at baseline (i.e., two or more fractures occurring simultaneously) had the highest refracture rate of 19.6%. As compared to the 50-65 age group, refracture risk increased monotonically with age group (66-70 years: HR = 1.3, CI 95%, 1.0-1.7; 71-80 years: HR = 1.7, CI 1.4-2.1; 81+ years: HR = 3.0, CI 2.4-3.7). Relative to distal radius, presenting with multiple fractures at screening was associated with a higher risk of refracture (HR = 2.3 CI 1.6-3.1), while presenting with an ankle fracture was associated with a lower risk of refracture (HR = 0.7 CI 0.6-0.9). Sex was not a statistically significant predictor of refracture risk in this cohort (HR = 1.2, CI 1.0-1.5).

CONCLUSIONS:

One in ten patients in our cohort refractured within 5 years after baseline. Presenting with multiple fractures was an indicator of a higher refracture risk, while presenting with an ankle fracture was associated with a lower refracture risk. A more targeted FLS approach may be appropriate for patients at a higher refracture risk.

KEYWORDS:

Fracture liaison service; Fragility fracture; Refracture rates; Refracture risk

PMID:
31152183
DOI:
10.1007/s00198-019-05017-3

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