Sticks and stones can break my bones – and so can aging. Risk of osteoporosis, a disease characterized by low bone mass and deteriorating bone tissue, increases with age, and so does increased risk of fracture. Known as the “silent thief,” deterioration can occur gradually without any symptoms. For post-menopausal women, the risk is even greater.
By the time a break has occurred, the disease is usually advanced. The most common fractures associated with osteoporosis are in the hip, spine, wrist, and shoulder. An estimated 70% to 90% of hip fractures are caused by this chronic disease, which has no clearcut cause.
According to a new study of Ontarians aged 65 and up, hip fracture predicts subsequent hip fracture. Any type of fracture in older adults is a significant predictor of a subsequent hip fracture, especially within the following two years.
The results reinforce the importance of early hip fracture prevention strategies for those in this age category. Given the rapid ageing of Canada’s population, the healthcare costs associated with hip fractures alone are predicted to increase to $2.4 billion by 2041.
“Hip fractures are often considered one of the most serious types of fracture because they frequently result in a devastating loss of independence and increased mortality,” says Dr. Emil Schemitsch, an orthopedic surgeon and one of the study’s lead authors. “The results of this study clearly support the need to recognize patients with a recent fracture as high risk for experiencing a future fracture and treat them accordingly, enhancing our hip fracture prevention efforts, especially following a first fracture.”
HIP STUDY RESULTS
- A hip fracture occurred on average within 1.5 years after any type of prior fracture.
- Hip fractures were the most common second fracture (27.8%).
- Among all fracture types related to osteoporosis, hip fractures contributed to 1 in 6 fracture-related surgeries and 1 in 7 post-surgical complications, such as heart attack, pneumonia and blood clot.
- Patients with prior hip fractures are 4x more likely to die within one year post hip fracture than their non-fracture counterparts.
A recent report from the Public Health Agency of Canada notes that fewer than 25% of patients with a hip fracture receive an intervention to prevent a future fracture. This in a sharp comparison to the estimated 80% of patients receiving an intervention after a heart attack.
“Patients with osteoporosis who have suffered hip fractures are clearly falling through the cracks,” says Dr. Samir Sinha, a geriatrician and director of geriatrics at Sinai Health and the University Health Network in Toronto.
“It is critical that we take osteoporosis more seriously and better appreciate how vulnerable patients who have experienced hip fractures are. We need to make it a national priority that these patients receive more appropriate assessment and care given the enormous societal consequences related to hip fractures.”
PROVIDING INTEGRATED CARE
In declaring 2021-2031 the United Nations’ Decade of Healthy Ageing, the UN emphasizes that providing more integrated care can be a crucial way to help improve both primary as well secondary fracture prevention after a prior fracture.
In Canada, Fracture Liaison Services (FLS) have been implemented at approximately 50 hospitals to ensure that, after an osteoporosis-related fracture, a patient gets assessed for their future fracture risk and, if appropriate, referred to an osteoporosis specialist.
As common as a heart attack in adults aged 80 and up, or in women aged 65 and up, the prevalence of hip fractures is expected to significantly increase due to an ageing population.
In fact, 1 in 4 Canadian women and 1 in 5 Canadian men aged 65+ living in the community at the time of experiencing a hip fracture, were found to enter a long-term care home within 1 year.
Likewise, 1 in 3 adults aged 50-80 and 2 in 3 aged more than 80 will require the use of a walking aid within 1 year of their hip fracture surgery. Although compared to Canadian women, men are 2 times less likely to fracture their hip, they are 1.3 times more likely to die following a hip fracture.
In Canada, an estimated 10% of all adults aged 40 and 21% of post-menopausal women have osteoporosis. The disease is responsible for approximately 200,000 cases of fragility fractures annually.
In 2014, the annual cost of osteoporosis was estimated to exceed $4.6 billion. Increased screening of high-risk individuals and treatment-initiation may reduce the rate of fractures and lead to significant cost savings.
While osteoporosis is largely preventable, hundreds of thousands of Canadians with osteoporosis still go undetected and untreated.
ABOUT THE STUDY
A cohort of 115,776 patients aged 65 or more with an index fracture occurring at skeletal sites related to age-related bone loss was identified using health services data from Ontario. This study was financially supported by Amgen Canada, with main operations located in Mississauga, Ont.’s biomedical cluster, and a research facility in Burnaby, B.C.
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