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. 2022 Apr;33(4):783-790.
doi: 10.1007/s00198-021-06205-w. Epub 2021 Oct 23.

Outcomes post fragility fracture among members of an integrated healthcare organization

Annette L Adams  1 , Denison S Ryan  1 , Bonnie H Li  1 , Setareh A Williams  2 , Yamei Wang  3 , Richard J Weiss  4 , Dennis M Black  1   5
Affiliations

Outcomes post fragility fracture among members of an integrated healthcare organization

Annette L Adams et al. Osteoporos Int. 2022 Apr.

Abstract

This study highlights an unmet need in osteoporosis management, suggesting that beyond bone mineral density and fracture history, gender, fracture type, and age should be considered for fracture risk assessment. Following fragility fracture, men, patients with a spine or hip fracture, and those aged ≥ 65 have a higher disease burden.

Introduction: The objective of this study was to characterize osteoporosis-related fracture incidence and identify predictors of subsequent fractures and mortality.

Methods: This retrospective cohort study, conducted within Kaiser Permanente Southern California, included patients aged ≥ 50 years with qualifying fractures from 1/1/2007 to 12/31/2016, identified from diagnosis/procedure codes. Rates for fracture incidence, mortality, and resource utilization in the year post-fracture are reported. Associations between index fracture types and demographic/clinical characteristics, and mortality, subsequent fracture, and rehospitalization outcomes were estimated.

Results: Of 63,755 eligible patients, 66.7% were ≥ 65 years and 69.1% female. Index fractures included nonhip/nonspine (64.4%), hip (25.3%), and spine (10.3%). Age-adjusted subsequent fracture rate/100 person-years was higher for those with an index spine (14.5) versus hip fracture (6.3). Hospitalization rate/100 person-years was highest for patients ≥ 65 (31.8) and for spine fractures (43.5). Men (vs women) had higher age-adjusted rates of hospitalization (19.4; 17.7), emergency room visits (73.8; 66.3), and use of rehabilitation services (31.7; 27.2). The 30-day age-adjusted mortality rate/100 person-years was 46.7, 32.4, and 15.5 for spine, hip, and nonspine/nonhip fractures. The 1-year age-adjusted mortality rate/100 person-years was 14.7 for spine and 15.6 for hip fractures. In multivariable analyses, spine and hip fractures (vs nonhip/nonspine fractures) were significant predictors of 1-year mortality, all-cause and osteoporosis-related hospitalization, and nursing home use (all P-values < 0.0001).

Conclusion: Morbidity is high in the year following a fragility fracture and men, patients with a spine or hip fracture, and those aged ≥ 65 have a greater disease burden.

Keywords: Fracture risk; Mortality; Osteoporosis; Subsequent fracture.

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Conflict of interest statement

Financial: Annette L. Adams is an employee of Kaiser Permanente which received funding from Radius Health, Inc. to conduct the study. Denison S. Ryan is an employee of Kaiser Permanente which received funding from Radius Health, Inc. to conduct the study. Bonnie H. Li is an employee of Kaiser Permanente which received funding from Radius Health, Inc. to conduct the study. Setareh A. Williams is an employee and shareholder of Radius Health, Inc. Yamei Wang is an employee and shareholder of Radius Health, Inc. Richard J. Weiss is a former employee and shareholder of Radius Health, Inc. Dennis M. Black provided consultancy for EffRx Pharmaceuticals, received research funding from Radius Health, Inc., and is on a data safety monitoring board for Eli Lilly (non-bone related).

Personal: The authors declare that they have no personal conflicts.

Figures

Fig. 1
Fig. 1
Cumulative incidence of fracture within 1 year, by index fracture type
Fig. 2
Fig. 2
Cumulative incidence of mortality within 1 year, by index fracture type
See this image and copyright information in PMC

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