Osteoporosis International

, Volume 23, Issue 9, pp 2381–2386 | Cite as

Institutionalization following incident non-traumatic fractures in community-dwelling men and women

  • S. MorinEmail author
  • L. M. Lix
  • M. Azimaee
  • C. Metge
  • S. R. Majumdar
  • W. D. Leslie
Short Communication



Institutionalization after hip fracture occurs in at least 30% of patients in the year following hospital discharge. We demonstrate that the risk of transfer to a long-term care facility, after adjustment for age and burden of co-morbidity, is also increased following fractures at other osteoporotic sites in men and women. For most fractures, men are at greater risk than women.


High institutionalization rates have been documented following non-traumatic hip fractures; however, there is lack of knowledge regarding the frequency of transfer to long-term care institutions of patients who sustain such fractures at other anatomical sites.


Using the comprehensive health care databases of the province of Manitoba, Canada, we performed a retrospective matched cohort study of community-dwelling men and women aged 50 years and older who sustained an incident non-traumatic fracture between April 1, 1986, and March 31, 2006. Using Cox proportional hazards regression analysis, we estimated the sex-specific relative risk of transfers to long-term care institutions in the year following fracture at osteoporotic sites.


We identified a total of 70,264 individuals with incident fractures (70.0% in women) among whom 3,996 new admissions to long-term care institutions were documented in the year following the index fracture. New admissions increased over time (p < 0.0001 for temporal trends). The age- and co-morbidity-adjusted hazard ratio (HR) of institutionalization following a hip fracture was 4.89 (95% confidence interval [CI], 4.19 to 5.69) in men, and this risk was consistently at least twice that of controls for all other fracture sites (all p < 0.0001). In women, the relative risks were highest subsequent to a hip (HR, 2.79; 95% CI, 2.56 to 3.04) or vertebral fracture (HR, 2.18; 95% CI, 1.82 to 2.62).


Non-traumatic fractures at any site have serious consequences, including institutionalization. Men are at greater risk of transfer to long-term care following fracture than women.


Cohort study Fractures Institutionalization Long-term care Osteoporosis 



The authors acknowledge the Manitoba Centre for Health Policy for use of data contained in the Population Health Research Data Repository under HIPC project # 2008/2009–16. The results and conclusions are those of the authors, and no official endorsement by the Manitoba Centre for Health Policy, Manitoba Health, or other data providers is intended or should be inferred.

Source of funding and role of the sponsor

Amgen Canada provided a research grant to the authors but was not represented on the research team, did not have direct access to data, did not participate in the analyses, and was not involved in the preparation or publication of this manuscript. SM is chercheur-clinicien boursier des Fonds de la Recherche en Santé du Québec. SRM is a Health Scholar supported by the Alberta Heritage Foundation for Medical Research. LML is supported by a Canadian Institutes of Health Research (CIHR) New Investigator Award and a Centennial Research Chair at the University of Saskatchewan.

Conflicts of interest

Suzanne Morin is consultant to Amgen, Novartis, and Eli Lilly, was part of the speaker bureau of Amgen and Novartis, and received a research grant from Amgen. Lisa Lix and Colleen Metge received research grants from Amgen Canada. Mahmoud Azimaee and Sumit R. Majumdar have no conflict of interest. William Leslie was part of the speaker bureau and received unrestricted research grants from Merck Frosst Canada. He received research honoraria and unrestricted educational grants from Sanofi-Aventis and Procter & Gamble Pharmaceuticals Canada, research grants from Novartis and Amgen Canada, and unrestricted educational grants from Genzyme Canada. He was part of the advisory boards of Genzyme Canada, Novartis, and Amgen Canada.


  1. 1.
    Sambrook P, Cooper C (2006) Osteoporosis. Lancet 367:2010–2018PubMedCrossRefGoogle Scholar
  2. 2.
    Marks R (2010) Hip fracture epidemiological trends, outcomes, and risk factors, 1970–2009. Int J Gen Med 3:1–17PubMedGoogle Scholar
  3. 3.
    Bonar SK, Tinetti ME, Speechley M, Cooney LM (1990) Factors associated with short- versus long-term skilled nursing facility placement among community-living hip fracture patients. J Am Geriatr Soc 38:1139–1144PubMedGoogle Scholar
  4. 4.
    Wiktorowicz ME, Goeree R, Papaioannou A, Adachi JD, Papadimitropoulos E (2001) Economic implications of hip fracture: health service use, institutional care and cost in Canada. Osteoporos Int 12:271–278PubMedCrossRefGoogle Scholar
  5. 5.
    Beaupre LA, Cinats JG, Senthilselvan A, Scharfenberger A, Johnston DW, Saunders LD (2005) Does standardized rehabilitation and discharge planning improve functional recovery in elderly patients with hip fracture? Arch Phys Med Rehabil 86:2231–2239PubMedCrossRefGoogle Scholar
  6. 6.
    Leslie WD, Sadatsafavi M, Lix LM et al (2011) Secular decreases in fracture rates 1986–2006 for Manitoba, Canada: a population-based analysis. Osteoporos Int 22:2137–2143PubMedCrossRefGoogle Scholar
  7. 7.
    Lix LM, Yogendran MS, Leslie WD et al (2008) Using multiple data features improved the validity of osteoporosis case ascertainment from administrative databases. J Clin Epidemiol 61:1250–1260PubMedCrossRefGoogle Scholar
  8. 8.
    Leslie WD, Giangregorio LM, Yogendran M et al (2011) A population-based analysis of the post-fracture care gap 1996–2008: the situation is not improving. Osteoporos Int (in press)Google Scholar
  9. 9.
    Bessette L, Ste-Marie LG, Jean S et al (2008) The care gap in diagnosis and treatment of women with a fragility fracture. Osteoporos Int 19:79–86PubMedCrossRefGoogle Scholar
  10. 10.
    Kanis JA, Oden A, Johnell O, Jonsson B, De Laet C, Dawson A (2001) The burden of osteoporotic fractures: a method for setting intervention thresholds. Osteoporos Int 12:417–427PubMedCrossRefGoogle Scholar
  11. 11.
    Morin S, Lix LM, Azimaee M, Metge C, Caetano P, Leslie WD (2011) Mortality rates after incident non-traumatic fractures in older men and women. Osteoporos Int 22:2439–2448PubMedCrossRefGoogle Scholar
  12. 12.
    Smith NS, Weiner JP (1994) Applying population-based case mix adjustment in managed care: the Johns Hopkins Ambulatory Care Group system. Manag Care Q 2:21–34PubMedGoogle Scholar
  13. 13.
    Zekry D, Loures Valle BH, Graf C et al (2011) Prospective comparison of 6 comorbidity indices as predictors of 1-year post-hospital discharge institutionalization, readmission, and mortality in elderly individuals. J Am Med Dir Assoc (in press)Google Scholar
  14. 14.
    Melton L Jr (2003) Adverse outcomes of osteoporotic fractures in the general population. J Bone Miner Res 18:1139–1141PubMedCrossRefGoogle Scholar
  15. 15.
    Ioannidis G, Papaioannou A, Hopman WM et al (2009) Relation between fractures and mortality: results from the Canadian Multicentre Osteoporosis Study. CMAJ 181:265–271PubMedCrossRefGoogle Scholar
  16. 16.
    Chrischilles EA, Butler CD, Davis CS, Wallace RB (1991) A model of lifetime osteoporosis impact. Arch Intern Med 151:2026–2032PubMedCrossRefGoogle Scholar
  17. 17.
    Fransoo RMP, Burland E (2009) The need to know team, Prior H, Burchill C. Manitoba RHA Indicators Atlas 2009Google Scholar
  18. 18.
    Doupe MFR, Chateau D, Dik N, Burchill C, Soodeen R, Bozat-Emre S, Guenette W (2011) Population aging and the continuum of older adult care in ManitobaGoogle Scholar
  19. 19.
    Curtis JR, Mudano AS, Solomon DH, Xi J, Melton ME, Saag KG (2009) Identification and validation of vertebral compression fractures using administrative claims data. Med Care 47:69–72PubMedCrossRefGoogle Scholar
  20. 20.
    Roos LL, Walld RK, Romano PS, Roberecki S (1996) Short-term mortality after repair of hip fracture. Do Manitoba elderly do worse? Med Care 34:310–326PubMedCrossRefGoogle Scholar
  21. 21.
    Bolland MJ, Grey AB, Gamble GD, Reid IR (2010) Effect of osteoporosis treatment on mortality: a meta-analysis. J Clin Endocrinol Metab 95:1174–1181PubMedCrossRefGoogle Scholar
  22. 22.
    Papaioannou A, Morin S, Cheung AM et al (2010) Clinical practice guidelines for the diagnosis and management of osteoporosis in Canada: summary. CMAJ 182:1864–1873PubMedCrossRefGoogle Scholar
  23. 23.
    Majumdar SR, Lier DA, Rowe BH et al (2011) Cost-effectiveness of a multifaceted intervention to improve quality of osteoporosis care after wrist fracture. Osteoporos Int 22:1799–1808PubMedCrossRefGoogle Scholar
  24. 24.
    Majumdar SR, Johnson JA, McAlister FA et al (2008) Multifaceted intervention to improve diagnosis and treatment of osteoporosis in patients with recent wrist fracture: a randomized controlled trial. CMAJ 178:569–575PubMedCrossRefGoogle Scholar
  25. 25.
    Sale JE, Beaton DE, Elliot-Gibson VI, Bogoch ER, Ingram J (2010) A postfracture initiative to improve osteoporosis management in a community hospital in ontario. J Bone Joint Surg Am 92:1973–1980PubMedCrossRefGoogle Scholar

Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2011

Authors and Affiliations

  • S. Morin
    • 1
    Email author
  • L. M. Lix
    • 2
  • M. Azimaee
    • 3
  • C. Metge
    • 3
  • S. R. Majumdar
    • 4
  • W. D. Leslie
    • 3
  1. 1.Division of General Internal MedicineMcGill University Health Center (MUHC)MontrealCanada
  2. 2.University of SaskatchewanSaskatoonCanada
  3. 3.University of ManitobaWinnipegCanada
  4. 4.University of AlbertaEdmontonCanada

Personalised recommendations