Dataset Information

Fragility fracture identifies patients at imminent risk for subsequent fracture: real-world retrospective database study in Ontario, Canada.

ABSTRACT:

Background

The secondary fracture prevention gap in the osteoporosis field has been previously described as a 'crisis'. Closing this gap is increasingly important in the context of accumulating evidence showing that an incident fragility fracture is associated with an increased risk of subsequent fracture within 1-2?years, known as imminent fracture risk. The objective of this study was to use health services data to characterize the time between index fragility fractures occurring at different osteoporotic sites and subsequent fractures.

Methods

This retrospective observational study used de-identified health services data from the publicly funded healthcare system in Ontario, the largest province of Canada. Patients aged >?65 with an index fragility fracture occurring between 2011 and 2015 were identified from the ICES Data Repository using International Classification of Diseases (ICD)-10 codes. We examined median time to subsequent fragility fractures for osteoporotic fracture sites until the end of follow-up (2017). BMD assessment and use of osteoporosis therapies following index fracture were also characterized.

Results

Among 115,776 patients with an index fragility fracture, 17.8% incurred a second fragility fracture. Median time between index and second fracture occurring at any site was 555?days (interquartile range: 236-955). For each index fracture site examined, median time from index to second fracture was ?3?years post index fracture.

Conclusions

This cohort of Canadian patients aged >?65?years who experienced a fragility fracture at any site are at imminent risk of experiencing subsequent fracture within the next 2?years and should be proactively assessed and treated.

SUBMITTER: Adachi JD

PROVIDER: S-EPMC7908684 | biostudies-literature | 2021 Feb

REPOSITORIES: biostudies-literature

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Publications

Fragility fracture identifies patients at imminent risk for subsequent fracture: real-world retrospective database study in Ontario, Canada.

Adachi Jonathan D JD Brown Jacques P JP Schemitsch Emil E Tarride Jean-Eric JE Brown Vivien V Bell Alan D AD Reiner Maureen M Packalen Millicent M Motsepe-Ditshego Ponda P Burke Natasha N Slatkovska Lubomira L

BMC musculoskeletal disorders 20210226 1

<h4>Background</h4>The secondary fracture prevention gap in the osteoporosis field has been previously described as a 'crisis'. Closing this gap is increasingly important in the context of accumulating evidence showing that an incident fragility fracture is associated with an increased risk of subsequent fracture within 1-2 years, known as imminent fracture risk. The objective of this study was to use health services data to characterize the time between index fragility fractures occurring at di ...[more]

PMID: 33637078

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Project description:BackgroundRecent studies are lacking reports on mortality after non-hip fractures in adults aged >?65.MethodsThis 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.ResultsThe 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.ConclusionsIn 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.

Project description:This study examined the imminent risk of a future fracture within 1 and 2 years following a first fracture in women aged 50 years and older and assessed independent factors associated with risk of subsequent fractures. The study highlights the need to intervene rapidly after a fracture to prevent further fractures. INTRODUCTION:This study aims to determine the imminent risk of subsequent fractures within 1 and 2 years following a first fracture and to assess independent factors associated with subsequent fractures. METHODS:Retrospective, observational cohort study of women aged ≥ 50 years with a fragility fracture was identified from Swedish national registers. Clinical/demographic characteristics at the time of index fracture and cumulative fracture incidences up to 12 and 24 months following index fracture were calculated. Risk factors for subsequent fracture were identified using multivariate regression analysis. RESULTS:Two hundred forty-two thousand one hundred eight women (mean [SD] age 74 [12.5] years) were included. The cumulative subsequent fracture incidence at 12 months was 7.1% (95% confidence interval [CI], 6.9-7.2) and at 24 months was 12.0% (95% CI, 11.8-12.1). The rate of subsequent fractures was highest in the first month (~ 15 fractures per 1000 patient-years) and remained steady between 4 and 24 months (~ 5 fractures/1000 patient-years). Higher age was an independent risk factor for imminent subsequent fractures (at 24 months, sub-distribution hazard ratio [HR], 3.07; p < 0.001 for women 80-89 years [reference 50-59 years]). Index vertebral fracture was a strong independent risk factor for subsequent fracture (sub-distribution HR, 2.72 versus hip fracture; p < 0.001 over 12 months; HR, 2.23; p < 0.001 over 24 months). CONCLUSIONS:Our findings highlight the need to intervene rapidly after any fragility fracture in postmenopausal women. The occurrence of a fragility fracture provides healthcare systems with a unique opportunity to intervene to reduce the increased risk of subsequent fractures.

Project description:This study demonstrates real-world effectiveness of teriparatide in reducing the risk of hip and other fragility fractures. Fracture incidence significantly decreased as adherence and persistence increased for any clinical, vertebral, nonvertebral, and hip fractures among patients who were observed for 2 years after teriparatide initiation.IntroductionExamine the relationship of treatment adherence and persistence to teriparatide with hip and other fractures.MethodsTruven MarketScan Research Databases, 2004 through 2014, provided teriparatide users ?18 years old with continuous coverage 12 months pre- and 24 months post-teriparatide prescription. Adherence (medication possession ratio, MPR) groups were defined as high (?0.80), medium (0.50 ? MPR < 0.80), and low (<0.50). Persistence, allowing for ?90-day gaps between prescriptions, was defined as 1-6, 7-12, 13-18, and 19-24 months. Fracture incidence was summarized and compared by using ANOVA and logistic regression models; the effects of adherence were examined with Cox proportional hazard models with time-dependent covariates for teriparatide exposure.ResultsAmong 14,284 teriparatide subjects, mean age was 68.4 years, 89.8% were female, and 29.6% had a fracture in the previous year; these characteristics were similar across MPR and persistence groups. The effects of adherence and persistence to teriparatide were statistically significant (P < .001) for all fracture types except wrist (P ? .125). By logistic regression, high vs low adherence was associated with reduced risk for any (OR = 0.67; P < .001); vertebral (OR = 0.64; P < .001); nonvertebral (OR = 0.71; P < .001); and hip fractures (OR = 0.52; P < .001) and longer (19-24 months) vs shorter persistence (1-6 months) was associated with reduced risk for any (OR = 0.63, P < .001); vertebral (OR = 0.56, P < .001); nonvertebral (OR = 0.69, P < .001); and hip fractures (OR = 0.48, P < .001). Cox models revealed a significantly reduced risk between high and low adherence for any (OR = 0.69, P < .001); vertebral (OR = 0.60, P < .001); nonvertebral (OR = 0.77, P < .001); and hip fractures (OR = 0.55, P < .001).ConclusionFracture incidence significantly decreased as persistence and adherence to teriparatide increased.

Project description:Using a matched cohort design, the 1-year excess cost of incident fragility fractures at any site was $26,341 per patient, with 43% of total excess costs attributed to hospitalization. The high economic burden of fractures in Ontario underscores the urgency of closing the secondary fracture prevention gap.IntroductionThis retrospective real-world observational study was conducted to document the incremental costs associated with fragility fractures in Ontario, Canada.MethodsPatients aged >65 years with an index fragility fracture occurring between January 2011 and March 2015 were identified from administrative databases and matched 1:1 to a cohort of similar patients without a fracture. Healthcare resource utilization data were extracted from healthcare records and associated costs were calculated on a per-patient level and for the province of Ontario. Costs were presented as 2017 Canadian dollars.ResultsThe eligible cohort included 115,776 patients with a fragility fracture. Of these, 101,773 patients were successfully matched 1:1 to a non-fracture cohort. Overall, hip fractures (n = 31,613) were the most common, whereas femur fractures (n = 3002) were the least common type. Hospitalization and continuing care/home care/long-term care accounted for more than 60% of 1-year direct costs, whereas 5% was attributed to medication costs. First-year costs per patient in the fracture cohort were approximately threefold higher versus the non-fracture cohort (mean $37,362 versus $11,020, respectively). The incremental first-year direct healthcare costs of fragility fractures for the province of Ontario were calculated at $724 million per year.ConclusionsFragility fractures were associated with a threefold increase in overall mean healthcare costs per patient compared to patients without fractures. With an aging population, there is an urgent need for improved prevention strategies for patients at high-risk of fracture to decrease the economic burden of fragility fractures on the Canadian healthcare system.

Project description:Background:The Ontario MedsCheck program was introduced in April 2007, with enhancements to strengthen the program made in October 2016. Previous literature has characterized patients who received the service before the enhancements and described the experiences of community pharmacists and physicians, but the experiences of participants in the enhanced MedsCheck program and those of hospital pharmacists and pharmacy technicians have not been explored. Objectives:This study was designed to describe and compare the demographic and clinical characteristics of patients admitted to Sunnybrook Health Sciences Centre (SHSC) who had received a MedsCheck before and after the program enhancements of 2016. The study also aimed to describe the experiences of patients, hospital pharmacists, and pharmacy technicians with the MedsCheck program. Methods:Chart reviews were completed to identify and characterize patients who had received a MedsCheck and were admitted to SHSC between March and May 2016 (retrospective cohort) and between March and May 2017 (prospective cohort). Patients were interviewed and focus groups were conducted with pharmacy staff to explore their experiences with the MedsCheck program. Results:MedsChecks had been performed for 321 (14.5%) of 2216 patients in the retrospective cohort and 172 (6.8%) of 2547 patients in the prospective cohort, an absolute decline of 7.7% after the 2016 enhancements. Patient characteristics were similar between the 2 cohorts. Patients' experiences were varied, but because of low enrolment in the interview process (n = 3), it was difficult to identify and summarize common themes. The analysis of focus groups involving pharmacy staff (n = 27 participants) revealed that the benefits of MedsChecks depended on quality and access, and also identified common barriers and opportunities for future enhancements. Conclusions:Patient interviews revealed the features of the program that patients valued. Pharmacy staff identified several benefits and barriers encountered when using MedsChecks. These findings can guide clinicians in optimal application of the current MedsCheck program and can inform subsequent program revisions.

Dataset Information

Fragility fracture identifies patients at imminent risk for subsequent fracture: real-world retrospective database study in Ontario, Canada.

Background

Methods

Results

Conclusions

Publications

Fragility fracture identifies patients at imminent risk for subsequent fracture: real-world retrospective database study in Ontario, Canada.

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