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

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. Intro...

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Bibliographic Details
Published in:Osteoporosis international 2019-08, Vol.30 (8), p.1671-1677
Main Authors: Sujic, R., Beaton, D.E., Mamdani, M., Cadarette, S.M., Luo, J., Jaglal, S., Sale, J.E.M., Jain, R., Bogoch, E.
Format: Article
Language:English
Subjects:
Age
Age Distribution
Aged
Aged, 80 and over
Ankle
Ankle Fractures - epidemiology
Endocrinology
Female
Follow-Up Studies
Fractures, Multiple - epidemiology
Hip
Humans
Humerus
Kaplan-Meier Estimate
Male
Mass Screening - organization & administration
Medicine
Medicine & Public Health
Middle Aged
Ontario - epidemiology
Original Article
Orthopedics
Osteoporotic Fractures - epidemiology
Osteoporotic Fractures - prevention & control
Pelvis
Recurrence
Rheumatology
Risk Assessment - methods
Risk Factors
Secondary Prevention - organization & administration
Statistical analysis
Time Factors
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Summary: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.
ISSN:0937-941X
1433-2965
DOI:10.1007/s00198-019-05017-3