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Comparative Study
. 2016 Mar;27(3):887-897.
doi: 10.1007/s00198-015-3477-3. Epub 2016 Jan 22.

Comparative trends in incident fracture rates for all long-term care and community-dwelling seniors in Ontario, Canada, 2002-2012

A Papaioannou  1   2 , C C Kennedy  3 , G Ioannidis  3   4   5 , C Cameron  6 , R Croxford  7 , J D Adachi  5 , S Mursleen  3 , S Jaglal  8
Affiliations
Comparative Study

Comparative trends in incident fracture rates for all long-term care and community-dwelling seniors in Ontario, Canada, 2002-2012

A Papaioannou et al. Osteoporos Int. 2016 Mar.

Abstract

Summary: In this population-based study, we compared incident fracture rates in long-term care (LTC) versus community seniors between 2002 and 2012. Hip fracture rates declined more rapidly in LTC than in the community. An excess burden of fractures occurred in LTC for hip, pelvis, and humerus fractures in men and hip fractures only in women.

Introduction: This study compares trends in incident fracture rates between long-term care (LTC) and community-dwelling seniors ≥65 years, 2002-2012.

Methods: This is a population-based cohort study using administrative data. Measurements were age/sex-adjusted incident fracture rates and rate ratios (RR) and annual percent change (APC).

Results: Over 11 years, hip fracture rates had a marked decline occurring more rapidly in LTC (APC, -3.49 (95% confidence interval (CI), -3.97, -3.01)) compared with the community (APC, -2.93 (95% CI, -3.28, -2.57); p < 0.05 for difference in slopes). Humerus and wrist fracture rates decreased; however, an opposite trend occurred for pelvis and spine fractures with rates increasing over time in both cohorts (all APCs, p < 0.05). In 2012, incident hip fracture rates were higher in LTC than the community (RRs: women, 1.55 (95% CI, 1.45, 1.67); men, 2.18 (95% CI, 1.93, 2.47)). Higher rates of pelvis (RR, 1.48 (95% CI, 1.22, 1.80)) and humerus (RR, 1.40 (95% CI, 1.07, 1.84)) fractures were observed in LTC men, not women. In women, wrist (RR, 0.76 (95% CI, 0.71, 0.81)) and spine (RR, 0.52 (95% CI, 0.45, 0.61)) fracture rates were lower in LTC than the community; in men, spine (RR, 0.75 (95% CI, 0.57, 0.98) but not wrist fracture (RR, 0.91 (95% CI, 0.67, 1.23)) rates were significantly lower in LTC than the community.

Conclusion: Previous studies in the community have shown declining hip fracture rates over time, also demonstrated in our study but at a more rapid rate in LTC. Rates of humerus and wrist fractures also declined. An excess burden of fractures in LTC occurred for hip fractures in women and for hip, pelvis, and humerus fractures in men.

Keywords: Community-dwelling seniors; Incident fracture rates; Long-term care; Ontario.

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Conflict of interest statement

Conflicts of interests Alexandra Papaioannou received grants/funds from Amgen, Eli Lilly, and Merck, a honoraria from Amgen and Eli Lilly, participated in a speaker forum for Amgen and Eli Lilly, and was a consultant for Amgen and Eli Lilly. Jonathan D. Adachi received grants/funds from Actavis, Amgen, Eli Lilly, Merck, and Novartis, a honoraria from Amgen, Eli Lilly, Merck, and Novartis, participated in a speaker forum for Amgen, Eli Lilly, Merck, and Novartis, acted as a consultant for Amgen, Eli Lilly, Merck, and Novartis, and is a board member for the International Osteoporosis Foundation. Courtney Kennedy, George Ioannidis, Cathy Cameron, Ruth Croxford, Sara Mursleen, and Susan Jaglal have no conflicts of interest to declare.

Figures

Fig. 1
Fig. 1
Annual number of fractures for LTC and community residents, 2002/2003 to 2012/2013
Fig. 2
Fig. 2
Age/sex-specific fracture rates per 10,000 in LTC and community cohorts, 2012/2013
Fig. 3
Fig. 3
Join point analysis of age/sex-standardized fracture rates per 10,000, LTC versus community, 2002/2003 to 2012/2013
See this image and copyright information in PMC

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