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BMC Musculoskeletal Disorders
Published in: BMC Musculoskeletal Disorders 1/2021

Open Access 01-12-2021 | Osteoporosis | Research article

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

Authors: Jacques P. Brown, Jonathan D. Adachi, Emil Schemitsch, Jean-Eric Tarride, Vivien Brown, Alan Bell, Maureen Reiner, Thiago Oliveira, Ponda Motsepe-Ditshego, Natasha Burke, Lubomira Slatkovska

Published in: BMC Musculoskeletal Disorders | Issue 1/2021

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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.
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Metadata
Title
Mortality in older adults following a fragility fracture: real-world retrospective matched-cohort study in Ontario
Authors
Jacques P. Brown
Jonathan D. Adachi
Emil Schemitsch
Jean-Eric Tarride
Vivien Brown
Alan Bell
Maureen Reiner
Thiago Oliveira
Ponda Motsepe-Ditshego
Natasha Burke
Lubomira Slatkovska
Publication date
01-12-2021
Publisher
BioMed Central
Published in
BMC Musculoskeletal Disorders / Issue 1/2021
Electronic ISSN: 1471-2474
DOI
https://doi.org/10.1186/s12891-021-03960-z

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