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