Oral Presentation ESA-SRB-ANZBMS 2024 in conjunction with ENSA

Beyond the break: how multimorbidity drives up refracture and mortality rates in low-trauma fracture cases in Australia (#135)

Mike Lin 1 2 , Thanh Nguyen 3 , Thach Tran 1 4 , Dana Bliuc 1 5 , Jackie R Center 1 2
  1. Bone Epidemiology, Clinical and Translation Science Lab, Garvan Institute of Research, Sydney, NSW, Australia
  2. School of Clinical Medicine St Vincent’s Healthcare Clinical Campus, Faculty of Medicine and Health UNSW , Sydney, NSW, Australia
  3. Production Bioinformatics, Data Science Platform, Garvan Institute of Research, Sydney , NSW, Australia
  4. School of Biomedical Engineering, University of Technology, Sydney, NSW, Australia
  5. School Of Population Health, Faculty of Medicine and Health UNSW , Sydney, NSW, Australia

Aim: Multimorbidity is common at the time of low-trauma fracture and impacts the severe adverse post-fracture outcomes. Traditional measures of multimorbidity count do not adequately identify individuals at high risk [1-3]. This study aims to define clusters of multimorbidity at the time of fracture based on the severity of chronic conditions. The second aim is to identify the impact of these clusters on refracture and post-fracture mortality.  

Methods: Whole-of-population linkage cohort consisting of adults aged ≥50 years in NSW from January 2005 to December 2020 with follow up until December 2022. Fractures and 72 comorbidities from Charlson Index, Elixhauser Index and ICD-10 codes related to musculoskeletal conditions were identified through hospital admissions, emergency presentations and cancer diagnoses. Latent class analysis was used to identify multimorbidity clusters, and cause-specific age-adjusted hazard ratios quantified excess subsequent refracture and mortality risk.

Results: Among 355,717 adults with incident low-trauma fractures, 107,664 (43%) were male (mean [SD] age, 75.7 [13.2] years) and 248,053 (57%) were female (77.4 [11.5] years). Over a median follow-up of 4.9 (IQR 2.0-9.2) years, 18,460 males (17%) and 61,746 females (25%) experienced subsequent fractures, while 54,378 males (51%) and 110,398 females (44.5%) died. Half of the patients had ≥2 comorbidities. Identified clusters included low morbidity (52.5% male, 60.1% female), diabetes (20.6% male, 17.3% female), neurological/neurodegenerative (14.2% male, 11.4% female), cardiovascular (9.1% male, 6.2% female), psychiatric (3.6% male, 3.3% female), and a separate rheumatology cluster for females (1.6%). Compared to the low morbidity cluster, all other multimorbidity clusters were associated with 1.4-2.3 fold increased risk of refracture and 1.7-3.7 fold increased risk of mortality in both sexes (figure 1).

Conclusion: This study identified 4-5 clusters of multimorbidity significantly associated with increased refracture and mortality risks. This underscores the need for tailored and comprehensive care strategies to manage these high-risk patients.

 

 

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