Abstract

Summary

Mortality rates in our fracture liaison service ranged from 2.7% at year 1 to 14.8% at year 5 post-screening. Presentation with multiple simultaneous fractures at screening was associated with higher risk of death. This finding indicates the need for increased focus on this high-risk group.

Purpose

To examine all-cause mortality rates in a provincial fracture liaison service (FLS) and the association between the index fracture type, particularly multiple simultaneous fractures, and the risk of death at follow-up.

Methods

This cohort study includes fragility fracture patients aged 50+, enrolled in a provincial FLS in Ontario, Canada, between 2007 and 2010. All-cause mortality was assessed using administrative data. Multivariable Cox proportional hazards model was used to examine the risk of death 5 years after screening.

Results

Crude mortality rates for 6543 fragility fracture patients were 2.7% at year 1, 5.6% at year 2, and 14.8% at year 5 after screening. After adjusting for age and sex, and relative to distal radius fracture, patients with multiple (simultaneous) fractures at screening had a higher risk of dying (HR = 1.8, 95%CI 1.3–2.4), followed by those with a hip fracture (HR = 1.5, 95%CI 1.3–1.8), a proximal humerus fracture (HR = 1.4, 95%CI 1.2–1.7), and other single fractures (HR = 1.4, 95%CI 1.1–1.7). Having an index ankle fracture was not associated with the risk of death over a distal radius fracture. As compared to the 50–65 age group, patients 66 years and older had a higher risk of death (for 66–70 age group: HR = 2.5, 95%CI 1.9–3.3; for 71–80: HR = 4.3, 95%CI 3.5–5.4; and for 81+: HR = 10.6, 95%CI 8.7–13.0). Females had a lower risk of death (HR = 0.5, 95%CI 0.5–0.6) than males.

Conclusions

Presenting with multiple fractures was an indicator of higher risk of death relative to a distal radius fracture. This finding indicates the need for increased focus on this high-risk group.

中文翻译：

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多个同时发生的骨折与更高的全因死亡率相关：全省范围的骨折联络服务的结果

摘要

概要

我们的骨折联络服务的死亡率从筛查后的第一年的2.7％到第五年的14.8％不等。筛查时同时出现多处骨折与较高的死亡风险相关。这一发现表明需要更加关注这一高风险人群。

目的

目的检查省级骨折联络处（FLS）的全因死亡率，以及指标骨折类型（尤其是多发同时骨折）与随访时死亡风险之间的关联。

方法

这项队列研究包括2007年至2010年在加拿大安大略省的FLS登记的50岁以上的脆性骨折患者。使用行政数据评估了全因死亡率。筛选后5年，使用多变量Cox比例风险模型检查死亡风险。

结果

筛查后，6543脆性骨折患者的粗死亡率在第1年为2.7％，在第2年为5.6％，在第5年为14.8％。在调整了年龄和性别以及相对于radius骨远端骨折后，筛查中多发（同时）骨折的患者死亡风险更高（HR = 1.8，95％CI 1.3-2.4），其次是髋部骨折（ HR = 1.5，95％CI 1.3–1.8），肱骨近端骨折（HR = 1.4，95％CI 1.2–1.7），其他单一骨折（HR = 1.4，95％CI 1.1–1.7）。踝关节指数骨折与radius骨远端骨折的死亡风险无关。与50-65岁年龄段相比，66岁及以上的患者死亡风险更高（对于66-70岁年龄段：HR = 2.5，95％CI 1.9-3.3；对于71-80岁年龄段：HR = 4.3，95 ％CI 3.5-5.4；对于81+：HR = 10.6，95％CI 8.7-13.0）。女性的死亡风险较低（HR = 0.5，

结论

与multiple骨远端骨折相比，多发骨折是较高的死亡风险指标。这一发现表明需要更加关注这一高风险人群。