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Fragility fracture patients with a history of prior fractures more likely to present with multiple risk factors: findings from a province-wide fracture liaison service

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Abstract

Summary

We examined the demographic characteristics and risk factors of FLS fragility fracture patients who had sustained prior fragility fracture(s) and found that this is an important high-risk subgroup that warrants further attention within FLS priority pathways in order to disrupt their fragility fracture cycle.

Purpose

Our primary objective was to examine whether fragility fracture patients presenting to a provincial fracture liaison service (FLS) having a history of prior fractures, versus those without, differ in demographic characteristics and risk factors for future fracture. A secondary objective was to understand if those who report two or more prior fractures differ from those reporting one prior fracture.

Methods

This cohort study included fragility fracture patients aged 50 + enrolled in the Ontario FLS between July 2017 and September 2019. Patients with versus those without prior fractures were compared on age, sex, index fracture site, biological parents’ history of hip fracture, current fracture due to a fall, history of feeling unsteady when walking, history of falls in the past year, smoking, oral steroid use, and comorbid chronic conditions. Pearson’s chi-square, Fischer’s exact, and analysis of variance tests were used to assess differences.

Results

Among 14,454 patients, 16.8% (n = 2428) reported a history of one or more prior fractures after the age of 40. They were significantly more likely to be older, female, with a higher number of comorbidities, with greater incidence of falls, and feel unsteady when walking. Compared to those with one prior fracture, patients with greater than one prior fracture were more likely to report falls in the past year and feel unsteady when walking.

Conclusion

Findings suggest that FLS fragility fracture patients who had sustained prior fragility fracture are an important high-risk subgroup that warrants further attention within FLS priority pathways in order to disrupt their fragility fracture cycle.

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Funding

This study was supported by funding from the Ontario Ministry of Health and Long-Term Care (MOHLTC) through the Ontario Osteoporosis Strategy. The views expressed are those of the researchers and do not necessarily reflect those of the MOHLTC.

Author information

Authors and Affiliations

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

    R. Sujic, A. Yang, V. Elliot-Gibson & J. E. M. Sale

  2. Brookfield Chair in Fracture Prevention, St. Michael’s Hospital, Unity Health Toronto, Toronto, Ontario, Canada

    R. Sujic, A. Yang, E. R. Bogoch & J. E. M. Sale

  3. Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada

    H. Ansari & J. E. M. Sale

  4. Department of Surgery, University of Toronto, Toronto, Ontario, Canada

    E. R. Bogoch & J. E. M. Sale

  5. Li Ka Shing Knowledge Institute of St. Michael’s Hospital, Unity Health Toronto, Toronto, Ontario, Canada

    E. R. Bogoch

  6. Ontario Osteoporosis Strategy, Osteoporosis Canada, Toronto, Ontario, Canada

    R. Jain & J. Weldon

Authors
  1. R. Sujic
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  2. A. Yang
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  3. H. Ansari
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  4. E. R. Bogoch
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  5. R. Jain
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  6. J. Weldon
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  7. V. Elliot-Gibson
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  8. J. E. M. Sale
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Corresponding author

Correspondence to R. Sujic.

Ethics declarations

Ethics approval

This project was performed as part of quality assurance and improvement of the provincial FLS, using de-identified data. Approval for usage of these data was obtained from the data custodians, Osteoporosis Canada.

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Conflict of interest

The authors RS, AY, HA, RJ, JW, VEG, and JEMS declare they have no conflict of interest. ERB has an unrestricted research grant from Amgen Canada and serves on an advisory board for Amgen Canada.

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Sujic, R., Yang, A., Ansari, H. et al. Fragility fracture patients with a history of prior fractures more likely to present with multiple risk factors: findings from a province-wide fracture liaison service. Osteoporos Int 33, 1769–1774 (2022). https://doi.org/10.1007/s00198-022-06384-0

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  • DOI: https://doi.org/10.1007/s00198-022-06384-0

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