Study results align with United Nations’ focus on maintaining functional independence, reinforces call for better integrated care to prevent hip fractures

MISSISSAUGA, ON, January 26, 2022 – Hip fractures are a hallmark fracture associated with osteoporosis with 70–90% of cases caused by this chronic disease. According to a study of Ontarians aged >65, Hip fracture predicts subsequent hip fracture: a retrospective observational study to support a call to early hip fracture prevention efforts in post fracture patients, any prior type of fracture in older adults is a significant predictor of a subsequent hip fracture, especially within the following 2 years.

The study results reinforce the importance of early hip fracture prevention strategies focusing on adults aged ≥65 and especially amongst those with a recent hip fracture to help reduce the high likelihood of experiencing a future hip fracture and their high social and human costs. 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 in Canada alone.ⁱ

The findings of this study are also aligned with the United Nations’ focus on maintaining functional independence and promoting better integrated care during their Decade of Healthy Ageing.ⁱⁱ

“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 very high risk for experiencing a future fracture and treat them accordingly, enhancing our hip fracture prevention efforts, especially following a first fracture.”

STUDY RESULTS
Key results of the study included the following:

• 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%), occurring in ≥19% of cases after each index fracture site and most frequently (33.0%) after an index hip fracture.
• Among all fracture types related to osteoporosis, hip fractures contributed to 1 in 6 fracture-related surgeries and 1 in 7 post-surgical complications (e.g., 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.ⁱⁱⁱ

As highlighted in a recent report from the Public Health Agency of Canada, <25% of patients with a hip fracture receive some type of an intervention to prevent a future fracture, which is in a sharp comparison to the estimated 80% of patients receiving an intervention after a heart attack to prevent another event.^iv

“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.”

In declaring 2021-2031 the United Nations’ Decade of Healthy Ageing, the UN has highlighted four specific areas to improve the lives of older people and their families and communities. Providing more integrated care is one of them and can be a crucial way to help improve both primary as well secondary fracture prevention after a prior hip or other fracture.

In Canada, Fracture Liaison Services (FLS) have been implemented at approximately 50 hospitals^v 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. In addition, their general practitioner is informed that they had an osteoporosis related event so they can be supported and monitored appropriately.

ABOUT HIP FRACTURES
As common as a heart attack in adults aged ≥ 80 or in women aged ≥ 65, the prevalence of hip fractures is expected to significantly increase due to an ageing population.^vi,iii In 2011, Canada’s baby boomers began turning 65 years of age and by 2031, 1 in 4 Canadians will be ≥ 65 years of age.^vii A hip fracture is sometimes described as a “bone attack”, since it is one of the most serious outcomes of osteoporosis.^iv,viii

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.^ix Likewise, 1 in 3 adults aged 50-80 and 2 in 3 aged >80 will require the use of a walking aid within 1 year of their hip fracture surgery.^x And although compared to Canadian women, men are 2x less likely to fracture their hip, they are 1.3x more likely to die following a hip fracture.^xi

ABOUT OSTEOPOROSIS
Osteoporosis is a skeletal disorder characterized by low bone mineral density (BMD) and increased risk of fragility fracture.^xii BMD decreases with age and declines more rapidly during menopause.^xiii

In Canada, an estimated 10% of all adults aged >40 years and 21% of post-menopausal women have osteoporosis.^xiii,xiv In Canada, osteoporosis is responsible for approximately 200,000 cases of fragility fractures annually.^xv As Canada’s population ages, the number of osteoporotic fractures is predicted to increase.^xvi

In 2014, the annual cost of osteoporosis in Canada was estimated to exceed 4.6 billion CAD.^xvii Increased screening of high-risk individuals and treatment-initiation may reduce the rate of fractures and lead to significant cost savings.

Osteoporosis is a largely preventable disease, yet hundreds of thousands of Canadians with osteoporosis still go undetected and untreated.^xviii

ABOUT THE STUDY
A cohort of 115,776 patients aged >65 with an index fracture occurring at skeletal sites related to age-related bone loss between January 1, 2011, and March 31, 2015, was identified using health services data from Ontario, Canada, and followed until March 31, 2017.

The primary objective of this study of was to characterize imminent risk of hip fracture by describing the frequency, distribution and median time to subsequent hip fracture, based on the site of initial fracture.

The secondary objectives were to describe the frequency and distribution of fracture-related surgeries, surgery-related complications, healthcare costs and mortality 1 year following a hip fracture, relative to other fracture sites.

This study was financially supported by Amgen Canada.

ABOUT AMGEN CANADA
As a leader in innovation, Amgen Canada understands the value of science. With main operations located in Mississauga, Ont.'s vibrant biomedical cluster, and its research facility in Burnaby, B.C., Amgen Canada has been an important contributor to advancements in science and innovation in Canada since 1991. The company contributes to the development of new therapies and new uses for existing medicines in partnership with many of Canada's leading health-care, academic, research, government and patient organizations. To learn more about Amgen Canada, visit www.amgen.ca.

MEDIA CONTACT
For further information:
Natasha Bond
Head of Corporate Affairs, Amgen Canada
905-285-3007
natasha.bond@amgen.com

ⁱ Wiktorowicz ME, Goeree R, Papaioannou A, Adachi JD, Papadimitropoulos E (2001) Economic implications of hip fracture: health service use, institutional care and cost in Canada. Osteoporos Int 12(4):271–278
ⁱⁱ UN Decade of Healthy Ageing. https://www.who.int/initiatives/decade-of-healthy-ageing
ⁱⁱⁱ Brown, J.P., Adachi, J.D., Schemitsch, E. et al. Mortality in older adults following a fragility fracture: real-world retrospective matched-cohort study in Ontario. BMC Musculoskelet Disord 22, 105 (2021). https://doi.org/10.1186/s12891-021-03960-z
^iv Osteoporosis and Related Fractures in Canada. Report from the Canadian Chronic Disease Surveillance System. Public Health Agency of Canada 2020. https://www.canada.ca/content/dam/phac-aspc/documents/services/publications/diseases-conditions/osteoporosis-related-fractures-2020/osteoporosis-related-fractures-2020.pdf
^v Kendler, D., Adachi, J., Brown, J. et al. A scorecard for osteoporosis in Canada and seven Canadian provinces. Osteoporos Int 32, 123–132 (2021). https://doi.org/10.1007/s00198-020-05554-2
^vi Canadian Chronic Disease Surveillance System (CCDSS); Available at: https://health-infobase.canada.caccdss/data-tool/
^vii Bank of Canada. Aging Gracefully: Canada’s Inevitable Demographic Shift. https://www.bankofcanada.ca/wp-content/uploads/2012/04/remarks-040412.pdf
^viii Siris ES. Patients with hip fracture: what can be improved? Bone. 2006 Feb;38(2 Suppl 2):S8-12. doi: 10.1016/j.bone.2005.11.014. Epub 2006 Jan 9. PMID: 16406848.
^ix Nikitovic M, Wodchis WP, Krahn MD, Cadarette SM. Direct health-care costs attributed to hip fractures among seniors: a matched cohort study. Osteoporos Int. 2013;24(2):659-669. doi:10.1007/s00198-012-2034-6
^x Schemitsch EH, Sprague S, Heetveld MJ, Bzovsky S, Heels-Ansdell D, Zhou Q, Swiontkowski M, Bhandari M; FAITH Investigators. Loss of Independence After Operative Management of Femoral Neck Fractures. J Orthop Trauma. 2019 Jun;33(6):292-300. doi: 10.1097/BOT.0000000000001444. PMID: 30801388.
^xi Osteoporosis and Related Fractures in Canada. Report from the Canadian Chronic Disease Surveillance System. Public Health Agency of Canada 2020. https://www.canada.ca/content/dam/phac-aspc/documents/services/publications/diseases-conditions/osteoporosis-related-fractures-2020/osteoporosis-related-fractures-2020.pdf
^xii International Osteoporosis Foundation (2013) Bone Care for the Postmenopausal Woman.
^xiii Public Health Agency of Canada (2009) Fast Facts from the 2009 Canadian Community Health Survey - Osteoporosis Rapid Response. https://www.canada.ca/en/public-health/services/chronic-diseases/osteoporosis/what-impact-osteoporosis-what-canadians-doing-maintain-healthy-bones.html.
^xiv Özlem ALTINDA⁄, Abdurrahman ALTINDA⁄*, Neslihan SORAN, Ahmet DEM‹RKOLHarran Üniversitesi T›p Fakültesi Fiziksel T›p ve Rehabilitasyon Anabilim Dal›, fianl›urfa, Turkey*Harran Üniversitesi T›p Fakültesi Psikiyatri Anabilim Dal›, fianl›urfa, Turkey Quality of Life and Depression in Postmenopausal Women with Osteoporosis Available at http://www.ftrdergisi.com/uploads/sayilar/241/buyuk/61-641.pdf
^xv Osteoporosis Canada. Make the FIRST break the LAST with Fracture Liason Services: Appendix B: Fracture incidence and costs by province. 2013 [Available from: https://osteoporosecanada.ca/wp-content/uploads/FLS-TOOLKIT-App-B.pdf.
^xvi Papadimitropoulos EA, Coyte PC, Josse RG, Greenwood CE (1997) Current and projected rates of hip fracture in Canada. CMAJ 157 (10):1357-1363
^xvii Hopkins RB, Burke N, Von KC, Leslie WD, Morin SN, Adachi JD, Papaioannou A, Bessette L, Brown JP, Pericleous L, Tarride J (2016) The current economic burden of illness of osteoporosis in Canada. Osteoporos Int 27 (10):3023-3032
^xvii Osteoporosis Canada (2011) Towards a Fracture-Free Future. http://fls.osteoporosis.ca/wp-content/uploads/white-paper-march-2011.pdf.