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Osteoporos Int. 2019 Nov 13. doi: 10.1007/s00198-019-05207-z. [Epub ahead of print]

Multiple simultaneous fractures are associated with higher all-cause mortality: results from 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, Ontario, Canada. sujicr@smh.ca.
2
ICES, Toronto, Ontario, Canada.
3
Musculoskeletal Health and Outcomes Research, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada.
4
Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.
5
Institute for Work & Health, Toronto, Ontario, Canada.
6
Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada.
7
Mobility Program, St. Michael's Hospital, Toronto, Ontario, Canada.
8
Toronto Rehabilitation Institute - University Health Network, Toronto, Ontario, Canada.
9
Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada.
10
Ontario Osteoporosis Strategy, Osteoporosis Canada, Toronto, Ontario, Canada.
11
Li Ka Shing Centre for Healthcare Analytics Research & Training, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada.

Abstract

Mortality rates in our fracture liaison service ranged from 2.7% at year 1 to 14.8% at year 5 post-screening. Presentation with multiple simultaneous fractures at screening was associated with higher risk of death. This finding indicates the need for increased focus on this high-risk group.

PURPOSE:

To examine all-cause mortality rates in a provincial fracture liaison service (FLS) and the association between the index fracture type, particularly multiple simultaneous fractures, and the risk of death at follow-up.

METHODS:

This cohort study includes fragility fracture patients aged 50+, enrolled in a provincial FLS in Ontario, Canada, between 2007 and 2010. All-cause mortality was assessed using administrative data. Multivariable Cox proportional hazards model was used to examine the risk of death 5 years after screening.

RESULTS:

Crude mortality rates for 6543 fragility fracture patients were 2.7% at year 1, 5.6% at year 2, and 14.8% at year 5 after screening. After adjusting for age and sex, and relative to distal radius fracture, patients with multiple (simultaneous) fractures at screening had a higher risk of dying (HR = 1.8, 95%CI 1.3-2.4), followed by those with a hip fracture (HR = 1.5, 95%CI 1.3-1.8), a proximal humerus fracture (HR = 1.4, 95%CI 1.2-1.7), and other single fractures (HR = 1.4, 95%CI 1.1-1.7). Having an index ankle fracture was not associated with the risk of death over a distal radius fracture. As compared to the 50-65 age group, patients 66 years and older had a higher risk of death (for 66-70 age group: HR = 2.5, 95%CI 1.9-3.3; for 71-80: HR = 4.3, 95%CI 3.5-5.4; and for 81+: HR = 10.6, 95%CI 8.7-13.0). Females had a lower risk of death (HR = 0.5, 95%CI 0.5-0.6) than males.

CONCLUSIONS:

Presenting with multiple fractures was an indicator of higher risk of death relative to a distal radius fracture. This finding indicates the need for increased focus on this high-risk group.

KEYWORDS:

Fracture liaison service; Fragility fracture; Mortality rates; Multiple fractures; Risk of death

PMID:
31720710
DOI:
10.1007/s00198-019-05207-z

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