Fragility fracture identifies patients at imminent risk for subsequent fracture: real-world retrospective database study in Ontario, Canada

BMC Musculoskeletal Disorders

Ponda Motsepe-Ditshego¹  Lubomira Slatkovska¹  Millicent Packalen¹  Natasha Burke¹  Maureen Reiner²  Jacques P. Brown³  Vivien Brown⁴  Alan D. Bell⁴  Jean-Eric Tarride⁵  Jonathan D. Adachi⁶  Emil Schemitsch⁷ 

[1] Amgen Canada Inc., Mississauga, ON, Canada;Amgen Inc, California, USA;CHU de Québec Research Centre and Laval University, Québec, QC, Canada;Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada;Department of Health Research Methods, Evidence and Impact (HEI), McMaster University, Hamilton, ON, Canada;Programs for Assessment of Technology in Health, The Research Institute of St. Joe’s Hamilton, St Joseph’s Healthcare Hamilton, Hamilton, ON, Canada;Centre for Health Economics and Policy Analysis (CHEPA), McMaster University, Hamilton, ON, Canada;Department of Medicine, McMaster University, Hamilton, ON, Canada;Division of Orthopaedic Surgery, Western University, London, ON, Canada;

关键词: Osteoporosis;    Fragility fracture;    Subsequent fracture;    Real-world data;    Imminent fracture risk;    Post fracture care;    Secondary fracture prevention;   

DOI  :  10.1186/s12891-021-04051-9

来源: Springer

【 摘 要 】

BackgroundThe secondary fracture prevention gap in the osteoporosis field has been previously described as a ‘crisis’. Closing this gap is increasingly important in the context of accumulating evidence showing that an incident fragility fracture is associated with an increased risk of subsequent fracture within 1–2 years, known as imminent fracture risk. The objective of this study was to use health services data to characterize the time between index fragility fractures occurring at different osteoporotic sites and subsequent fractures.MethodsThis retrospective observational study used de-identified health services data from the publicly funded healthcare system in Ontario, the largest province of Canada. Patients aged > 65 with an index fragility fracture occurring between 2011 and 2015 were identified from the ICES Data Repository using International Classification of Diseases (ICD)-10 codes. We examined median time to subsequent fragility fractures for osteoporotic fracture sites until the end of follow-up (2017). BMD assessment and use of osteoporosis therapies following index fracture were also characterized.ResultsAmong 115,776 patients with an index fragility fracture, 17.8% incurred a second fragility fracture. Median time between index and second fracture occurring at any site was 555 days (interquartile range: 236–955). For each index fracture site examined, median time from index to second fracture was < 2 years. The proportion of patients with BMD assessment was 10.3% ≤1 year prior to and 16.4% ≤1 year post index fracture. The proportion of patients receiving osteoporosis therapy was 29.8% ≤1 year prior, 34.6% ≤1 year post, and 25.9% > 3 years post index fracture.ConclusionsThis cohort of Canadian patients aged > 65 years who experienced a fragility fracture at any site are at imminent risk of experiencing subsequent fracture within the next 2 years and should be proactively assessed and treated.

【 授权许可】

CC BY