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

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Abstract

Summary

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.

Introduction

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

Methods

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.

Results

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).

Conclusions

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.

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Acknowledgments

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

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

Author information

Authors and Affiliations

  1. Musculoskeletal Health and Outcomes Research, Li Ka Shing Knowledge Institute of St. Michael’s Hospital, Toronto, ON, Canada

    R. Sujic, D.E. Beaton & J.E.M. Sale

  2. Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada

    D.E. Beaton, M. Mamdani & J.E.M. Sale

  3. Institute for Work & Health, Toronto, ON, Canada

    D.E. Beaton

  4. Li Ka Shing Centre for Healthcare Analytics Research & Training, Li Ka Shing Knowledge Institute of St. Michael’s Hospital, Toronto, ON, Canada

    M. Mamdani

  5. Institute for Clinical Evaluative Sciences, Toronto, ON, Canada

    M. Mamdani, S.M. Cadarette, J. Luo & S. Jaglal

  6. Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada

    M. Mamdani & S.M. Cadarette

  7. Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada

    S.M. Cadarette

  8. Toronto Rehabilitation Institute – University Health Network, Toronto, ON, Canada

    S. Jaglal

  9. Department of Physical Therapy, University of Toronto, Toronto, ON, Canada

    S. Jaglal

  10. Ontario Osteoporosis Strategy, Osteoporosis Canada, Toronto, ON, Canada

    R. Jain

  11. Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada

    E. Bogoch

  12. Mobility Program, St. Michael’s Hospital, Toronto, ON, Canada

    E. Bogoch

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  1. R. Sujic
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  9. E. Bogoch
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Consortia

the Ontario Osteoporosis Strategy Fracture Screening and Prevention Program Evaluation Team

Corresponding author

Correspondence to R. Sujic.

Ethics declarations

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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Sujic, R., Beaton, D., Mamdani, M. et al. Five-year refracture rates of a province-wide fracture liaison service. Osteoporos Int 30, 1671–1677 (2019). https://doi.org/10.1007/s00198-019-05017-3

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  • DOI: https://doi.org/10.1007/s00198-019-05017-3

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