Institutionalization following incident non-traumatic fractures in community-dwelling men and women.
Institutionalization after hip fracture occurs in at least 30% of patients in the year following hospital discharge. We demonstrate that the risk of transfer to a long-term care facility, after adjustment for age and burden of co-morbidity, is also increased following fractures at other osteoporotic sites in men and women. For most fractures, men are at greater risk than women.


BACKGROUND
High institutionalization rates have been documented following non-traumatic hip fractures; however, there is lack of knowledge regarding the frequency of transfer to long-term care institutions of patients who sustain such fractures at other anatomical sites.


METHODS
Using the comprehensive health care databases of the province of Manitoba, Canada, we performed a retrospective matched cohort study of community-dwelling men and women aged 50 years and older who sustained an incident non-traumatic fracture between April 1, 1986, and March 31, 2006. Using Cox proportional hazards regression analysis, we estimated the sex-specific relative risk of transfers to long-term care institutions in the year following fracture at osteoporotic sites.


RESULTS
We identified a total of 70,264 individuals with incident fractures (70.0% in women) among whom 3,996 new admissions to long-term care institutions were documented in the year following the index fracture. New admissions increased over time (p < 0.0001 for temporal trends). The age- and co-morbidity-adjusted hazard ratio (HR) of institutionalization following a hip fracture was 4.89 (95% confidence interval [CI], 4.19 to 5.69) in men, and this risk was consistently at least twice that of controls for all other fracture sites (all p < 0.0001). In women, the relative risks were highest subsequent to a hip (HR, 2.79; 95% CI, 2.56 to 3.04) or vertebral fracture (HR, 2.18; 95% CI, 1.82 to 2.62).


CONCLUSIONS
Non-traumatic fractures at any site have serious consequences, including institutionalization. Men are at greater risk of transfer to long-term care following fracture than women.
Division of General Internal Medicine, McGill University Health Center (MUHC), 1650 Cedar Ave., Montreal, QC, Canada. suzanne.morin@mcgill.ca
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Azimaee
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Metge
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D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D005260:Female; D005598:Fractures, Spontaneous / Q000453:epidemiology*; D006620:Hip Fractures / Q000453:epidemiology; D006801:Humans; D006810:Humeral Fractures / Q000453:epidemiology; D007326:Institutionalization / Q000706:statistics & numerical data*; D008134:Long-Term Care; D008297:Male; D008350:Manitoba / Q000453:epidemiology; D008875:Middle Aged; D058866:Osteoporotic Fractures / Q000453:epidemiology*; D012189:Retrospective Studies; D012307:Risk Factors; D016103:Spinal Fractures / Q000453:epidemiology; D014954:Wrist Injuries / Q000453:epidemiology