Oral Presentation 29th Australian and New Zealand Bone and Mineral Society Annual Scientific Meeting 2019

Multimorbidity and long-term mortality following a specific fragility fracture: Latent class analysis of a nationwide population-based cohort (#65)

Thach Tran 1 2 , Dana Bliuc 1 2 , Louise Hansen 3 , Bo Abrahamsen 4 5 , Tineke van Geel 6 , Joop van den Bergh 7 8 , John A Eisman 1 2 9 10 , Piet Geusens 11 12 , Peter Vestergaard 13 14 15 , Tuan V Nguyen 1 2 16 , Jackie Center 1 2 9
  1. Faculty of Medicine, University of New South Wales, Sydney, Australia
  2. Garvan Institute of Medical Research, Darlinghurst, NSW, Australia
  3. Danish Center for Healthcare Improvements, Aalborg, Aalborg East, Denmark
  4. Department of Medicine, Holbak Hospital, Holbak , Denmark
  5. Department of Clinical Research, Odense Patient Data Explorative Network, University of Southern Denmark, Odense, Denmark
  6. Department of Family Medicine, Maastricht University, Research School CAPHRI, Maastricht, The Netherlands
  7. Department of Internal Medicine, Subdivision of Rheumatology, Maastricht University Medical Center, Research school Nutrim, Maastricht, The Netherlands
  8. Department of Internal Medicine, VieCuri Medical Centre of Noord-Limburg, Venlo, The Netherlands
  9. School of Medicine Sydney, University of Notre Dame Australia, Sydney, Australia
  10. Clinical School, St Vincent's Hospital, Sydney, Australia
  11. Department of Internal Medicine, Maastricht University, Research School CAPHRI, Maastricht, The Netherlands
  12. University Hasselt, Biomedical Research Institute, Hasselt, Belgium
  13. Department of Clinical Endocrinology, Aalborg University Hospital, Aalborg, Denmark
  14. Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
  15. Steno Diabetes Center , North Jutland, Denmark
  16. School of Biomedical Engineering, University of Technology Sydney, Sydney, NSW, Australia

Elderly fracture patients often have multiple comorbidities but little is known about multimorbidity pattern and how this might affect mortality post-fracture. We sought to determine the patterns and impact of multimorbidity on mortality following specific fracture types.

This nationwide Danish population-based study included all individuals aged 50+ years who sustained an incident fragility fracture 2001-2014. Morbidities included 33 unique conditions of Charlson or Elixhauser index. Latent class analysis was used to identify patterns of multimorbidity, and corrected Dxy index to quantify their discrimination ability on post-fracture mortality.

During a median of 6.5 years of follow-up, 95,372 men with a fragility fracture (age at fracture: 72± 11) and 212,498 women (75± 11) sustained 41,017 and 81,727 deaths, respectively. Fracture as a group and specific fracture types shared similar distinct multimorbidity classes: (1) low multimorbidity (60.4% men, 65.6% women), (2) cardiovascular (24%, 23%), (3) diabetes/vascular (5.6%, 3.8%), (4) rheumatologic (5.1%, 3.2%), and (5) cancer (5.0%, 4.4%) (Figure). Distal fractures had a high proportion of low multimorbidity than proximal fractures (72% in hand vs. 48% in hip fractures). Mortality risk in patients with the higher morbidity classes was 1.5-to-3-fold greater than low multimorbidity (class 1). However, this pattern was less obvious among proximal fracture patients (e.g. hip, femur, pelvis, vertebrae) than distal fractures (forearm, hand, foot). The impact of multimorbidity on prediction of mortality was also worse for proximal (Dxy index< 0.45 in men and 0.40 in women) than for distal fractures (> 0.55, 0.60).

Comorbidities at fracture time clustered into 5 distinct patterns in which the higher multimorbidity classes were associated with increased mortality risk. Despite higher multimorbidity observed for proximal fractures, the impact of multimorbidity on mortality was greater for distal fractures. This study highlights the need for more comprehensive approaches in fracture patients with multimorbidity to individualise patient care.

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