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. 2021 Jan 23;22(1):105.
doi: 10.1186/s12891-021-03960-z.

Mortality in older adults following a fragility fracture: real-world retrospective matched-cohort study in Ontario

Jacques P Brown  1 , Jonathan D Adachi  2 , Emil Schemitsch  3 , Jean-Eric Tarride  4   5   6 , Vivien Brown  7 , Alan Bell  7 , Maureen Reiner  8 , Thiago Oliveira  9 , Ponda Motsepe-Ditshego  9 , Natasha Burke  9 , Lubomira Slatkovska  10
Affiliations

Mortality in older adults following a fragility fracture: real-world retrospective matched-cohort study in Ontario

Jacques P Brown et al. BMC Musculoskelet Disord. .

Abstract

Background: Recent studies are lacking reports on mortality after non-hip fractures in adults aged > 65.

Methods: This retrospective, matched-cohort study used de-identified health services data from the publicly funded healthcare system in Ontario, Canada, contained in the ICES Data Repository. Patients aged 66 years and older with an index fragility fracture occurring at any osteoporotic site between 2011 and 2015 were identified from acute hospital admissions, emergency and ambulatory care using International Classification of Diseases (ICD)-10 codes and data were analyzed until 2017. Thus, follow-up ranged from 2 years to 6 years. Patients were excluded if they presented with an index fracture occurring at a non-osteoporotic fracture site, their index fracture was associated with a trauma code, or they experienced a previous fracture within 5 years prior to their index fracture. This fracture cohort was matched 1:1 to controls within a non-fracture cohort by date, sex, age, geography and comorbidities. All-cause mortality risk was assessed.

Results: The survival probability for up to 6 years post-fracture was significantly reduced for the fracture cohort vs matched non-fracture controls (p < 0.0001; n = 101,773 per cohort), with the sharpest decline occurring within the first-year post-fracture. Crude relative risk of mortality (95% confidence interval) within 1-year post-fracture was 2.47 (2.38-2.56) in women and 3.22 (3.06-3.40) in men. In the fracture vs non-fracture cohort, the absolute mortality risk within one year after a fragility fracture occurring at any site was 12.5% vs 5.1% in women and 19.5% vs 6.0% in men. The absolute mortality risk within one year after a fragility fracture occurring at a non-hip vs hip site was 9.4% vs 21.5% in women and 14.4% vs 32.3% in men.

Conclusions: In this real-world cohort aged > 65 years, a fragility fracture occurring at any site was associated with reduced survival for up to 6 years post-fracture. The greatest reduction in survival occurred within the first-year post-fracture, where mortality risk more than doubled and deaths were observed in 1 in 11 women and 1 in 7 men following a non-hip fracture and in 1 in 5 women and 1 in 3 men following a hip fracture.

Keywords: Fracture; Mortality; Older adults; Osteoporosis; Real-world.

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Conflict of interest statement

JPB has received consulting fees and honoraria from Amgen and Servier; received research funding from Mereo BioPharma, Radius Health and Servier; served on speakers’ bureau for Amgen. JDA has received consulting fees from Amgen and Eli Lilly; received research funding from Amgen, Pfizer, and BMS; served on the speakers’ bureau for Amgen; served on boards for the International Osteoporosis Foundation and Ontario Rheumatology Association. ES has received consulting fees from Amgen. J-ET has received consulting fees, research funding and honoraria from Allergan, AstraZeneca, Amgen, CSL Behring, Janssen, Novo Nordisk, Sage, Assurex/Myriad, Edwards Lifesciences, Pfizer, Roche, Merck, GlaxoSmithKline, Evidera, PCDI, CADTH. VB has received honoraria from Amgen and have served on Amgen Ad Boards. AB has received consulting fees, research funding and honoraria from Amgen, Bristol Myers Squibb, Janssen, AstraZeneca, Novartis, Pfizer, Bayer, Lilly, Boehringer Ingelheim, Sanofi, Valeant. LS, NB, PM-D, TO and MR are employees of and own stock in Amgen.

Figures

Fig. 1
Fig. 1
Flow diagram of fracture and non-fracture cohort adults included in the study. Note: ICD-10-CA, International Classification of Diseases, 10th revision, Canada; IKN, ICES key number. aAll patients with valid IKN with a non-trauma fracture occurring at an osteoporotic fracture site (hip, humerus, vertebral, wrist, pelvis, femur, clavicle/sternum, ribs, radius/ulna, or tibia/ fibula/knee) between January 1, 2011 and March 31, 2015. Fractures were identified using ICD-10-CA codes from hospital admissions, emergency room visits, and ambulatory care. bControls who did not experience a fracture between January 1, 2011 and March 31, 2015 or during the 5-year lookback period prior to their index date
Fig. 2
Fig. 2
Survival probability in the fracture cohort and non-fracture cohort. Note: Thickness of fracture and no fracture cohort curves represent 95% confidence intervals
See this image and copyright information in PMC

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