Osteoporosis International

, Volume 30, Issue 8, pp 1671–1677 | Cite as

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

  • R. SujicEmail author
  • D.E. Beaton
  • M. Mamdani
  • S.M. Cadarette
  • J. Luo
  • S. Jaglal
  • J.E.M. Sale
  • R. Jain
  • E. Bogoch
  • the Ontario Osteoporosis Strategy Fracture Screening and Prevention Program Evaluation Team
Original Article



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.


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


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.


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).


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.


Fragility fracture Fracture liaison service Refracture rates Refracture risk 



The views expressed are those of the researchers and do not necessarily reflect those of the Ontario Ministry of Health and Long Term Care. The data used in this study were linked using unique encoded identifiers and analyzed at the Institute for Clinical Evaluative Sciences. The authors gratefully acknowledge the support of Osteoporosis Canada and the Fracture Screening and Prevention Program Evaluation Team for their contribution to the overall evaluation of the program.

Funding information

This study was supported by funding from the Ontario Ministry of Health and Long Term Care (MOHLTC) through the Ontario Osteoporosis Strategy.

Compliance with ethical standards

Conflicts of interest

Rebeka Sujic: no disclosures. Dorcas E Beaton: no disclosures. Muhammad Mamdani: received Honoraria and served as a consultant/advisory board of Novo Nordisk, Allergan, and Amgen. Suzanne M Cadarette: no disclosures. Jin Luo: no disclosures. Susan Jaglal: no disclosures. Joanna EM Sale: no disclosures. Ravi Jain: no disclosures.

Earl R Bogoch received an unrestricted research grant and speaker fees from Amgen Canada Inc., and is an Editorial Board member for the Journal of Rheumatology.


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Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2019

Authors and Affiliations

  • R. Sujic
    • 1
    Email author
  • D.E. Beaton
    • 1
    • 2
    • 3
  • M. Mamdani
    • 2
    • 4
    • 5
    • 6
  • S.M. Cadarette
    • 5
    • 6
    • 7
  • J. Luo
    • 5
  • S. Jaglal
    • 5
    • 8
    • 9
  • J.E.M. Sale
    • 1
    • 2
  • R. Jain
    • 10
  • E. Bogoch
    • 11
    • 12
  • the Ontario Osteoporosis Strategy Fracture Screening and Prevention Program Evaluation Team
  1. 1.Musculoskeletal Health and Outcomes ResearchLi Ka Shing Knowledge Institute of St. Michael’s HospitalTorontoCanada
  2. 2.Institute of Health Policy, Management and EvaluationUniversity of TorontoTorontoCanada
  3. 3.Institute for Work & HealthTorontoCanada
  4. 4.Li Ka Shing Centre for Healthcare Analytics Research & TrainingLi Ka Shing Knowledge Institute of St. Michael’s HospitalTorontoCanada
  5. 5.Institute for Clinical Evaluative SciencesTorontoCanada
  6. 6.Leslie Dan Faculty of PharmacyUniversity of TorontoTorontoCanada
  7. 7.Dalla Lana School of Public HealthUniversity of TorontoTorontoCanada
  8. 8.Toronto Rehabilitation Institute – University Health NetworkTorontoCanada
  9. 9.Department of Physical TherapyUniversity of TorontoTorontoCanada
  10. 10.Ontario Osteoporosis Strategy, Osteoporosis CanadaTorontoCanada
  11. 11.Division of Orthopaedic Surgery, Department of SurgeryUniversity of TorontoTorontoCanada
  12. 12.Mobility Program, St. Michael’s HospitalTorontoCanada

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