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Erschienen in:
31.05.2019 | Original Article
Five-year refracture rates of a province-wide fracture liaison service
Erschienen in: Osteoporosis International | Ausgabe 8/2019
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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.