Five-year refracture rates of a province-wide fracture liaison service
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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.
KeywordsFragility 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.
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.
- 3.Adachi JD, Loannidis G, Berger C, Joseph L, Papaioannou A, Pickard L, Papadimitropoulos EA, Hopman W, Poliquin S, Prior JC, Hanley DA, Olszynski WP, Anastassiades T, Brown JP, Murray T, Jackson SA, Tenenhouse A (2001) The influence of osteoporotic fractures on health-related quality of life in community-dwelling men and women across Canada. Osteoporos Int 12:903–908CrossRefGoogle Scholar
- 27.Beaton DE, Mamdani M, Zheng H, Jaglal S, Cadarette SM, Bogoch ER, Sale JEM, Sujic R, Jain R (2017) Improvements in osteoporosis testing and care are found following the wide scale implementation of the Ontario Fracture Clinic Screening Program: an interrupted time series analysis. Medicine (Baltimore) 96:e9012CrossRefGoogle Scholar
- 28.Beaton DE, Vidmar M, Pitzul KB, Sujic R, Rotondi NK, Bogoch ER, Sale JEM, Jain R, Weldon J (2017) Addition of a fracture risk assessment to a coordinator's role improved treatment rates within 6 months of screening in a fragility fracture screening program. Osteoporos Int 28:863–869CrossRefGoogle Scholar
- 33.Ismail AA, O’Neill TW, Cockerill W, Finn JD, Cannata JB, Hoszowski K, Johnell O, Matthis C, Raspe H, Raspe A, Reeve J, Silman AJ (2000) Validity of self-report of fractures: results from a prospective study in men and women across Europe. EPOS Study Group European Prospective Osteoporosis Study Group. Osteoporos Int 11:248–254CrossRefGoogle Scholar