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Multiple simultaneous fractures are associated with higher all-cause mortality: results from a province-wide fracture liaison service


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.



Sujic R, Luo J, Beaton DE, Bogoch ER, Sale JEM, Jaglal S, Jain R, Mamdani M; the Ontario Osteoporosis Strategy Fracture Screening and Prevention Program Evaluation Team. Osteoporos Int. 2020; 31(2):291-6. Epub 2019 Nov 13.

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