Multiple simultaneous fractures are associated with higher all-cause mortality:​ results from a province-wide fracture liaison service

Sujic, R.; Luo, J.; Beaton, D. E.; Bogoch, E. R.; Sale, J. E. M.; Jaglal, S.; Jain, R.; Mamdani, M.

Affiliations

¹Musculoskeletal Health and Outcomes Research, Li Ka Shing Knowledge Institute of St. Michael’s Hospital, Toronto, Canada

²ICES, Toronto, Canada

³Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada

⁴Institute for Work & Health, Toronto, Canada

⁵Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, Canada

⁶Mobility Program, St. Michael’s Hospital, Toronto, Canada

⁷Toronto Rehabilitation Institute – University Health Network, Toronto, Canada

⁸Department of Physical Therapy, University of Toronto, Toronto, Canada

⁹Ontario Osteoporosis Strategy, Osteoporosis Canada, Toronto, Canada

¹⁰Li Ka Shing Centre for Healthcare Analytics Research & Training, Li Ka Shing Knowledge Institute of St. Michael’s Hospital, Toronto, Canada

Abstract and keywords

Summary: 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

Links

DOI: 10.1007/s00198-019-05207-z

PubMed: 31720710

WoS: 000496218000004

History

Received: 2019-05-27

Accepted: 2019-10-23

Online: 2019-11-13

Cited Works (7)

Year	Entry
2000	Klotzbuecher CM, Ross PD, Landsman PB, Abbott TA III, Berger M. Patients with prior fractures have an increased risk of future fractures: a summary of the literature and statistical synthesis. J Bone Miner Res. April 2000;15(4):721-739.
2011	Center JR, Bliuc D, Nguyen ND, Nguyen TV, Eisman JA. Osteoporosis medication and reduced mortality risk in elderly women and men. J Clin Endocrinol Metab. April 2011;96(4):1006-1014.
2013	Ganda K, Puech M, Chen JS, Speerin R, Bleasel J, Center JR, Eisman JA, March L, Seibel MJ. Models of care for the secondary prevention of osteoporotic fractures: a systematic review and meta-analysis. Osteoporos Int. February 2013;24(2):393-406.
2013	Åkesson K, Marsh D, Mitchell PJ, McLellan AR, Stenmark J, Pierroz DD, Kyer C, Cooper C. Capture the fracture: a best practice framework and global campaign to break the fragility fracture cycle. Osteoporos Int. August 2013;24(8):2135-2152.
2009	Bliuc D, Nguyen ND, Milch VE, Nguyen TV, Eisman JA, Center JR. Mortality risk associated with low-trauma osteoporotic fracture and subsequent fracture in men and women. JAMA. February 4, 2009;301(5):513-521.
2012	Eisman JA, Bogoch ER, Dell R, Harrington JT, McKinney RE Jr, McLellan A, Mitchell PJ, Silverman S, Singleton R, Siris E; ASBMR Task Force on Secondary Fracture Prevention. Making the first fracture the last fracture: ASBMR task force report on secondary fracture prevention. J Bone Miner Res. October 2012;27(10):2039-2046.
2004	Johnell O, Kanis JA, Odén A, Sernbo I, Redlund-Johnell I, Petterson C, De Laet C, Jönsson B. Fracture risk following an osteoporotic fracture. Osteoporos Int. March 2004;15(3):175-179.

Cited By (1)

Year	Entry
2021	McLaughlin EC. Cause or Consequence? The Interrelationship Between Physical Activity and Fractures [Master's thesis]. University of Waterloo; 2021.