Trends in osteoporotic fracture and related in-hospital complications during the COVID-19 pandemic in Alberta, Canada

Abstract

Fragility fractures (i.e., low-energy fractures) account for most fractures among older Canadians and are associated with significant increases in morbidity and mortality. Study results suggest that low-energy fracture rates (associated with surgical intervention and outcomes) declined slightly, but largely remained stable in the first few months of the COVID-19 pandemic.

Purpose/introduction: This study describes rates of low-energy fractures, time-to-surgery, complications, and deaths post-surgery in patients with fractures during the coronavirus disease (COVID-19) pandemic in Alberta, Canada, compared to the three years prior.

Methods: A repeated cross-sectional study was conducted using provincial-level administrative health data. Outcomes were assessed in 3-month periods in the 3 years preceding the COVID-19 pandemic and in the first two 3-month periods after restrictions were implemented. Patterns of fracture- and hospital-related outcomes over the control years (2017-2019) and COVID-19 restrictions periods (2020) were calculated.

Results: Relative to the average from the control periods, there was a slight decrease in the absolute number of low-energy fractures (n = 4733 versus n = 4308) during the first COVID-19 period, followed by a slight rise in the second COVID-19 period (n = 4520 versus n = 4831). While the absolute number of patients with low-energy fractures receiving surgery within the same episode of care decreased slightly during the COVID-19 periods, the proportion receiving surgery and the proportion receiving surgery within 24 h of admission remained stable. Across all periods, hip fractures accounted for the majority of patients with low-energy fractures receiving surgery (range: 58.9-64.2%). Patients with complications following surgery and in-hospital deaths following fracture repair decreased slightly during the COVID-19 periods.

Conclusions: These results suggest that low-energy fracture rates, associated surgeries, and surgical outcomes declined slightly, but largely remained stable in the first few months of the pandemic. Further investigation is warranted to explore patterns during subsequent COVID-19 waves when the healthcare system experienced severe strain.

Keywords: COVID-19; Fractures; In-hospital complications; Osteoporosis; Pandemic.

Fig. 1

Study design and COVID-19^† lockdown overview. ^†The COVID-19 State of Public Health Emergency in Alberta resulted in the temporary residential lockdown, closure/restricted access of public facilities, and cancellation of elective surgeries (i.e., lockdown period)

Fig. 2

(A) Number of overall fractures reported by period. Data are presented as an average over the 3-year control period (grey) and absolute for the COVID-19 period* (red). (B) Low-energy^† fractures presented as an average for the control period (grey) and as absolute for theCOVID-19 period. Abbreviations: N: number; Mar: March; Jun: June; Sept: September; COVID-19: coronavirus disease 2019 SARS-CoV-2 virus. *The COVID-19 State of Public Health Emergency in Alberta resulted in the temporary residential lockdown, closure/restricted access of public facilities, and cancellation of elective surgeries (i.e., lockdown period). †Low-energy fractures are defined as fractures sustained when falling from standing height or less

Fig. 3

Number of patients experiencing low-energy fracture* in Alberta, Canada, from 2017 to 2020 stratified by fracture site. Note: The grey shaded areas represent the control periods evaluated in this study. The red shaded area represents the COVID-19 pandemic period where in the first 3 months (Mar–Jun) a COVID-19 State of Public Health Emergency in Alberta was active, which resulted in a temporary residential lockdown, the closure/restricted access of public facilities, and the cancellation of elective surgeries (i.e., lockdown period). Abbreviations: Fx: fracture; N: number; Mar: March; Jun: June; Sep: September; Dec: December. *Low-energy fractures are defined as fractures sustained when falling from standing height or less

Fig. 4

All low-energy fracture repair and surgical intervention in less than 24 h. (A) The absolute number and change in percentage points from the previous year of patients who received a fracture diagnosis and surgical fracture repair code within the same episode of care for all low-energy fractures* and low-energy hip fractures*. (B) Patients receiving fracture repair surgery within 24 h of discharge from the ED^† for all low-energy fractures* and low-energy hip fractures* in Alberta, Canada (2017–2020). Abbreviations: COVID-19: coronavirus disease 2019 SARS-CoV-2 virus; second period; Mar: March; Sep: September; ED: Emergency Department. *Low-energy fractures are defined as fractures sustained when falling from standing height or less. ^†Data reported reflects the number of people diagnosed with a low-energy fracture who received surgical intervention within 24 h of discharge from the emergency department

Fig. 5

In-hospital deaths and complications post-fracture repair surgery, among patients with low-energy fractures who received surgery. (A) Proportion of patients with fracture diagnosis and surgical fracture repair codes within the same episode of care for all low-energy fractures* and low-energy hip fractures* who died in hospital following surgical fracture repair. (B) Proportion of patients with fracture diagnosis and surgical fracture repair codes within the same episode of care for all low-energy fractures* and low-energy hip fractures* who experienced complications post fracture repair. Complications are further stratified by type (infection, pneumonia, other). Abbreviations: Mar: March; Sep: September; *Low-energy fractures are defined as fractures sustained when falling from standing height or less