Abstract
Summary
We examined the impact of fragility fractures on the work outcomes of employed patients. The majority successfully returned to their previous jobs in a short amount of time, and productivity loss at work was low. Our findings underscore the fast recovery rates of working fragility fracture patients.
Introduction
The purpose of this study is to describe the impact of fragility fractures on the work outcomes of patients who were employed at the time of their fracture.
Methods
A self-report anonymous survey was mailed to fragility fracture patients over 50 who were screened as part of the quality assurance programs of fracture clinics across 35 hospitals in Ontario, Canada. Measures of return to work (RTW), at-work productivity loss (Work Limitations Questionnaire), and sociodemographic, fracture-related, and job characteristics were included in the survey. Kaplan-Meier estimates of the cumulative proportion of patients still off work were computed. Factors associated with RTW time following a fragility fracture were examined using Cox proportional hazards modeling.
Results
Of 275 participants, 242 (88 %) returned to work. Of these, the median RTW time was 20.5 days. About 86 % returned to the same job, duties, and hours as before their injury. Among full-time workers, the median number of lost hours due to presenteeism was 2.9 h (Q1–Q3 0.4–8.1 h). The median cost of presenteeism was $75.30 based on the month prior to survey completion. In multivariable analyses, female gender, needing surgery, and medium/heavy work requirements were associated with longer RTW time. Earlier RTW time was associated with elbow fracture and feeling completely better at time of survey completion.
Conclusions
The majority of fragility fracture patients successfully returned to their previous jobs in a short amount of time, and productivity loss at work was low. Our findings underscore their fast recovery rates and give reason for optimism regarding the resilience of this population.
Similar content being viewed by others
References
Galarneau D (2015) Portrait of Canada’s labour force: National Household Survey 2011. Statistics Canada. https://www12.statcan.gc.ca/nhs-enm/2011/as-sa/99-012-x/99-012-x2011002-eng.cfm. Accessed 11 Apr 2016
Marshall K, Ferrao V (2007) Participation of older workers. Perspectives on labour and income, Statistics Canada. http://www.statcan.gc.ca/pub/75-001-x/2007108/article/4235146-eng.pdf. Accessed 11 Apr 2016
Tarride J-E, Hopkins RB, Leslie WD, Morin S, Adachi JD, Papaioannou A, Bessette L, Brown JP, Goeree R (2012) The burden of illness of osteoporosis in Canada. Osteoporos Int 23:2591–2600. doi:10.1007/s00198-012-1931-z
Ganda K, Puech M, Chen JS, Speerin R, Bleasel J, Center JR, Eisman JA, March L, Seibel MJ (2013) Models of care for the secondary prevention of osteoporotic fractures: a systematic review and meta-analysis. Osteoporos Int 24:393–406. doi:10.1007/s00198-012-2090-y
Johnell O, Kanis JA, Oden A, Sernbo I, Redlund-Johnell I, Petterson C, De Laet C, Jonsson B (2004) Fracture risk following an osteoporotic fracture. Osteoporos Int 15:175–179. doi:10.1007/s00198-003-1514-0
Public Health Agency of Canada (2010) Fast facts from the 2009 Canadian Community Health Survey—osteoporosis rapid response. Statistics Canada. http://www.phac-aspc.gc.ca/cd-mc/osteoporosis-osteoporose/. Accessed 11 Apr 2016
Jaglal SB, Hawker G, Cameron C, Canavan J, Beaton DE, Bogoch E, Jain R, Papaioannou A, and members of the Osteoporosis Research MaEWG (2010) The Ontario osteoporosis strategy: implementation of a population-based osteoporosis action plan in Canada. Osteoporos Int 21:903–908. doi:10.1007/s00198-010-1206-5
Papaioannou A, Morin S, Cheung AM, Atkinson S, Brown JP, Feldman S, Hanley D, Hodsman A, Jamal SA, Josse RG, Kaiser SM, Kvern B, Siminoski K, Leslie WD, for the Scientific Advisory Council of Osteoporosis Canada (2010) Clinical practice guidelines for the diagnosis and management of osteoporosis in Canada: background and technical report. Osteoporosis Canada. http://www.osteoporosis.ca/multimedia/pdf/Osteoporosis_Guidelines_2010_Background_And_Technical_Report.pdf. Accessed 11 Apr 2016
Eekman DA, ter Wee MM, Coupe VMH, Erisek-Demirtas S, Kramer MH, Lems WF (2014) Indirect costs account for half of the total costs of an osteoporotic fracture: a prospective evaluation. Osteoporos Int 25:195–204. doi:10.1007/s00198-013-2505-4
Pike C, Birnbaum HG, Schiller M, Sharma H, Burge R, Edgell ET (2010) Direct and indirect costs of non-vertebral fracture patients with osteoporosis in the US. Pharmacoeconomics 28:395–409
Sasser AC, Rousculp MD, Birnbaum HG, Oster EF, Lufkin E, Mallet D (2005) Economic burden of osteoporosis, breast cancer, and cardiovascular disease among postmenopausal women in an employed population. Women Health Issues 15:97–108. doi:10.1016/j.whi.2004.11.006
Tarride J-E, Guo N, Hopkins R, Leslie WD, Morin S, Adachi JD, Papaioannou A, Bessette L, Brown JP, Goeree R (2012) The burden of illness of osteoporosis in Canadian men. J Bone Miner Res 27:1830–1838. doi:10.1002/jbmr.1615
Rabenda V, Manette C, Lemmens R, Mariani AM, Struvay N, Reginster JY (2006) The direct and indirect costs of the chronic management of osteoporosis: a prospective follow-up of 3440 active subjects. Osteoporos Int 17:1346–1352. doi:10.1007/s00198-005-0066-x
Lerner D, Amick BC, Rogers WH, Malspeis S, Bungay K, Cynn D (2001) The work limitations questionnaire. Med Care 39:72–85
Tang K, Boonen A, Verstappen SM, Escorpizo R, Luime JJ, Lacaille D, Fautrel B, Bosworth A, Cifaldi M, Gignac MA, Hofstetter C, Leong A, Montie P, Petersson IF, Purcaru O, Bombardier C, Tugwell PS, Beaton DE (2014) Worker productivity outcome measures: OMERACT filter evidence and agenda for future research. J Rheumatol 41:165–176. doi:10.3899/jrheum.130815
Tang K, Beaton DE, Amick BC III, Hogg-Johnson S, Cote P, Loisel P (2013) Confirmatory factor analysis of the Work Limitations Questionnaire (WLQ-25) in workers’ compensation claimants with chronic upper-limb disorders. J Occup Rehabil 23:228–238. doi:10.1007/s10926-012-9397-6
Beaton DE, Tang K, Gignac MA, Lacaille D, Badley EM, Anis AH, Bombardier C (2010) Reliability, validity, and responsiveness of five at-work productivity measures in patients with rheumatoid arthritis or osteoarthritis. Arthritis Care Res 62:28–37. doi:10.1002/acr.20011
National Occupational Classification (NOC) (2015) NOC Matrix 2011. Government of Canada. http://www5.hrsdc.gc.ca/NOC/English/NOC/2011/html/Matrix.html. Accessed 11 Apr 2016
National Occupational Classification (NOC) (2003) Career handbook, 2nd ed (revised). Government of Canada. http://www5.hrsdc.gc.ca/NOC/English/CH/2001/Welcome.aspx. Accessed 11 Apr 2016
National Occupational Classification (NOC) (2009) NOC Matrix 2006. Government of Canada. http://www30.hrsdc.gc.ca/NOC/English/NOC/2006/html/Matrix.html. Accessed 11 Apr 2016
Lerner D, Rogers WH, Chang W (2009) Technical report: scoring the Work Limitations Questionnaire (WLQ). Available from the authors upon request
Statistics Canada (2016) Table 282-0070—labour force survey estimates, wages of employees by type of work, National Occupational Classification for Statistics, sex and age group, annual, CANSIM (database). Government of Canada. http://www5.statcan.gc.ca/cansim/a05?lang=eng&id=2820070&pattern=2820070&searchTypeByValue=1&p2=35. Accessed 11 Apr 2016
Allison PD (2010) Survival analysis. In: Hancock GR, Mueller RO (eds) The reviewer’s guide to quantitative methods in the social sciences. Routledge, New York, pp 413–424
Abimanyi-Ochom J, Watts JJ, Borgstrom F, Nicholson GC, Shore-Lorenti C, Stuart AL, Zhang Y, Iuliano S, Seeman E, Prince R, March L, Cross M, Winzenberg T, Laslett LL, Duque G, Ebeling PR, Sanders KM (2015) Changes in quality of life associated with fragility fractures: Australian arm of the International Cost and Utility Related to Osteoporotic Fractures Study (AusICUROS). Osteoporos Int 26:1781–1790. doi:10.1007/s00198-015-3088-z
Zhang W, Gignac MAM, Beaton DE, Tang K, Anis AH (2010) Productivity loss due to presenteeism among patients with arthritis: estimates from 4 instruments. J Rheumatol 37:1805–1814. doi:10.3899/jrheum.100123
Burton WN, Chen C, Schultz AB, Conti DJ, Pransky G, Edington DW (2006) Worker productivity loss associated with arthritis. Dis Manag 9:131–143
Duckworth AD, Wickramasinghe NR, Clement ND, Court-Brown CM, McQueen MM (2014) Long-term outcomes of isolated stable radial head fractures. J Bone Joint Surg Am 96:1716–1723
Herbertsson P, Josefsson P-O, Hasserius R, Karlsson C, Besjakov J, Karlsson M (2004) Uncomplicated mason type-II and III fractures of the radial head and neck in adults. J Bone Joint Surg 86:569–574
Sankar A, Davis AM, Palaganas MP, Beaton DE, Badley EM, Gignac MA (2013) Return to work and workplace activity limitations following total hip or knee replacement. Osteoarthr Cartil 21:1485–1493
Gignac MAM, Cao X (2009) “Should I tell my employer and coworkers I have arthritis?” A longitudinal examination of self-disclosure in the work place. Arthritis Rheum 61:1753–1761. doi:10.1002/art.24889
Acknowledgments
This study has been supported through funding by the Ontario Ministry of Health and Long Term Care through the Ontario Osteoporosis Strategy. The views expressed are those of the authors and do not necessarily reflect those of the Ministry. The authors would like to acknowledge Dr. Peter Smith for his contribution in helping with the occupational coding system and Rebeka Sujic, Hina Ansari, and John Cullen for providing helpful feedback.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflicts of interest
None.
Ethical approval
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Rights and permissions
About this article
Cite this article
Rotondi, N.K., Beaton, D.E., Ilieff, M. et al. The impact of fragility fractures on work and characteristics associated with time to return to work. Osteoporos Int 28, 349–358 (2017). https://doi.org/10.1007/s00198-016-3730-4
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00198-016-3730-4