The post-fracture care gap among Canadian First Nations peoples: a retrospective cohort study

Leslie, William D.; Brennan, Sharon L.; Prior, Heather J.; Lix, Lisa M.; Metge, Colleen; Elias, Brenda

doi:10.1007/s00198-011-1880-y

Cited by 14 publications

(12 citation statements)

References 38 publications

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“…Fractures of a less serious nature may have been managed without visiting an emergency department and confirmed using private radiology services not included in our recruitment procedures. It is very likely that there are differences in fracture rates among Indigenous Australians consistent with racial differences identified between individuals of First Nations and white Canadians and in the USA between black Americans, Hispanic, and white Americans . However, there were no reliable published Australian data available to incorporate such differences into the analysis.…”

Section: Discussionmentioning

confidence: 99%

The Cost of Osteoporosis, Osteopenia, and Associated Fractures in Australia in 2017

Tatangelo

Watts

Lim

et al. 2019

Journal of Bone and Mineral Research

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Osteoporosis and osteopenia are increasingly prevalent conditions among older adults. Not only do the fractures associated with poor bone health have significant health consequences for the individual, but also their economic impact is placing increasing financial burden on governments and society. This study aimed to determine the direct economic cost of osteoporosis, osteopenia, and fractures among Australians aged 50 years and older in 2017. This study uses previous Australian data on the incidence and prevalence of osteoporosis and osteopenia together with recent Australian data on health service utilization after fracture to provide an estimate of the economic burden of osteoporosis. A bottom‐up costing approach was used to determine the average direct health care and non‐health care total costs of a fracture, as well as the average community health service costs of managing individuals with osteoporosis or osteopenia. The total direct cost of osteoporosis in Australia in 2017 was estimated to be $3.44 billion (AUD 2017, USD 2.77 billion). Treatment of fractures accounted for 68% of total direct costs, and non‐fracture management of osteoporosis accounted for 32%. Hip fractures accounted for the highest proportion (43%) of the total direct cost of fractures, although fractures at “other” sites accounted for 38.5%. Fractures among individuals aged 70 years and older accounted for 74% of the direct costs (55% and 19% in women and men, respectively). Fracture costs in those with osteopenia accounted for 50% of direct fracture treatment costs. This up‐to‐date cost analysis estimated that costs in 2017 were three times higher than in 2007. These estimates will aid clinicians, policy makers, researchers, and health care organizations to acknowledge the economic importance of reducing osteoporosis‐related fractures and associated costs. This provides a strong public health case to promote bone health that will assist in reducing future fracture‐related costs. © 2018 American Society for Bone and Mineral Research.

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Section: Discussionmentioning

confidence: 99%

The Cost of Osteoporosis, Osteopenia, and Associated Fractures in Australia in 2017

Tatangelo

Watts

Lim

et al. 2019

Journal of Bone and Mineral Research

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“…Even in a national healthcare system where individuals do not pay for BMD testing, large socioeconomic discrepancies have been reported (88). After a major osteoporotic fracture, Native Canadians were one half to one tenth as likely to receive BMD testing, osteoporosis treatment, or an osteoporosis diagnosis than the general population (89).…”

Section: Ethnic Differences In Osteoporosis Carementioning

confidence: 99%

Ethnic Differences in Bone Mass—Clinical Implications

Leslie

2012

The Journal of Clinical Endocrinology &Amp; Metabolism

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Context: Differences in bone mineral density (BMD) as assessed with dual-energy x-ray absorptiometry are observed between geographic and ethnic groups, with important implications in clinical practice.Evidence Acquisition: PubMed was employed to identify relevant studies. A review of the literature was conducted, and data were summarized and integrated.Evidence Synthesis: The available data highlight the complex ethnic variations in BMD, which only partially account for observed variations in fracture rates. Factors contributing to ethnic differences include genetics, skeletal size, body size and composition, lifestyle, and social determinants. Despite BMD differences, the gradient of risk for fracture from BMD and other clinical risk factors appears to be similar across ethnic groups. Furthermore, BMD variation is greater within an ethnic population than between ethnic populations. New imaging technologies have identified ethnic differences in bone geometry, volumetric density, microarchitecture, and estimated bone strength that may contribute to a better understanding of ethnic differences in fracture risk. O steoporosis is a global problem characterized by reduced bone strength and increased fracture risk (1, 2). Fifty-six million people worldwide were estimated to have suffered a prior osteoporotic fracture in 2000 (3). Although osteoporosis occurs in all populations, not all populations are at equal risk, as highlighted in a Clinical Symposium at the annual meeting of The Endocrine Society in 2012 (4). The burden of osteoporosis is projected to rise markedly over the next few decades (5), with the greatest increase among elderly non-Whites (6). This review summarizes some of the differences in bone mineral density (BMD) that have been observed between geographic and ethnic groups, and this may contribute to observed fracture rates. Conclusions Variation in Fracture RatesA systematic review identified greater than 10-fold variation in age-standardized hip fracture risk among 63 countries (7). Differences between countries were much greater than the male-female differences within a country. In broad terms, a band of high-risk countries stretched from Northern Europe through middle Europe and then south-eastward to eastern Europe and beyond. Ecological studies have noted a relationship between 10-yr hip fracture probability and latitude (ϳ0.6% increase for each 10°i ncrease in latitude) and also with economic prosperity (1.3% increase for each U.S. $10,000 in per capita gross domestic product) (8). Some have suggested that there may be much greater global variation in hip fracture rates than clinical vertebral fracture rates, although this requires further confirmation given the challenge of accurately measuring vertebral fracture rates (9).Historical patterns in hip fractures are changing. Hip fracture rates are declining in Western countries but increasing in many developing countries (10), with similar trends for other fracture sites (11-15). Increasing urbanization in developing countries such as China may...

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“…Our computer-assisted search strategy yielded 3227 articles, of which 708 were potentially eligible. After screening, 283 articles remained as potentially eligible; the full-texts of those articles were read and cross-referencing against our pre-determined criteria, and 262 full text articles were excluded, leaving 21 articles that met our selection criteria (Leslie et al, 2004, Leslie et al, 2005, Leslie et al, 2006, Leslie et al, 2012, Leslie et al, 2013, Cauley et al, 2007, Cauley et al, 2011, Adsett et al, 2013, Buchanan et al, 2005, Chen et al, 2010, Frech et al, 2012, Jandoc et al, 2015, Kieser et al, 2002, Kruger et al, 2006, MacIntosh and Pearson, 2001, MacMillan et al, 2010, Oberdan and Finn, 2007, Pratt and Holloway, 2001, Stott et al, 1980, Wong et al, 2013, Nelson et al, 2011). The most frequent reasons for articles failing to meet the eligibility criteria at this stage of the identification process were: archeological investigations of skeletons (n = 91); studies investigated bone mineral density (BMD); bone mineral content (BMC) or body composition (n = 50); study populations investigated with regards to ethnicity not indigenous status (n = 37); or dental-based studies (n = 31); with the remaining 53 articles excluded for other reasons (Table 1).…”

Section: Resultsmentioning

confidence: 99%

“…Combined, the studies encompassed analyses of approximately 123,000 indigenous persons; however, both the Women's Health Initiative dataset from the USA and the Province wide Manitoba administrative health database from Canada investigated in more than one study. Studies were performed in New Zealand (n = 7) (Adsett et al, 2013, Buchanan et al, 2005, Kieser et al, 2002, Stott et al, 1980, Barber et al, 1995, Norton et al, 1995, Koorey et al, 1992), the United States of America (USA) (n = 7) (Cauley et al, 2007, Cauley et al, 2011, Chen et al, 2010, Frech et al, 2012, Pratt and Holloway, 2001, Nelson et al, 2011, Barrett-Connor et al, 2005), Canada (n = 7) (Leslie et al, 2004, Leslie et al, 2005, Leslie et al, 2006, Leslie et al, 2012, Leslie et al, 2013, Jandoc et al, 2015, MacMillan et al, 2010), Australia (n = 5) (Kruger et al, 2006, MacIntosh and Pearson, 2001, Oberdan and Finn, 2007, Wong et al, 2013, Orchard et al, 2013) and Mexico (n = 1) (Beyene and Martin, 2001). Standardized, age-adjusted and/or annualized incident fracture rates or ratios were presented within 14 of the 27 articles, multivariable analyses were presented within 5 of the included articles, and 12 of the articles presented only descriptive results or had presented adjusted analyses that were not relevant to this systematic review; for instance time to mortality post-fracture for indigenous compared to non-indigenous persons (Leslie et al, 2013), the number of football games missed following fracture for indigenous compared to non-indigenous players (Orchard et al, 2013), the role played by parathyroid hormone (Cauley et al, 2011) or anemia status (Chen et al, 2010) on fracture risk within a group of indigenous persons, or the post-fracture care-gap among indigenous compared to non-indigenous populations (Leslie et al, 2012).…”

Section: Resultsmentioning

confidence: 99%

Fractures in indigenous compared to non-indigenous populations: A systematic review of rates and aetiology

et al. 2017

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BackgroundCompared to non-indigenous populations, indigenous populations experience disproportionately greater morbidity, and a reduced life expectancy; however, conflicting data exist regarding whether a higher risk of fracture is experienced by either population. We systematically evaluate evidence for whether differences in fracture rates at any skeletal site exist between indigenous and non-indigenous populations of any age, and to identify potential risk factors that might explain these differences.MethodsOn 31 August 2016 we conducted a comprehensive computer-aided search of peer-reviewed literature without date limits. We searched PubMed, OVID, MEDLINE, CINAHL, EMBASE, and reference lists of relevant publications. The protocol for this systematic review is registered in PROSPERO, the International Prospective Register of systematic reviews (CRD42016043215). Using the World Health Organization reference population as standard, hip fracture incidence rates were re-standardized for comparability between countries.ResultsOur search yielded 3227 articles; 283 potentially eligible articles were cross-referenced against predetermined criteria, leaving 27 articles for final inclusion. Differences in hip fracture rates appeared as continent-specific, with lower rates observed for indigenous persons in all countries except for Canada and Australia where the opposite was observed. Indigenous persons consistently had higher rates of trauma-related fractures; the highest were observed in Australia where craniofacial fracture rates were 22-times greater for indigenous compared to non-indigenous women. After adjustment for socio-demographic and clinical risk factors, approximately a three-fold greater risk of osteoporotic fracture and five-fold greater risk of craniofacial fractures was observed for indigenous compared to non-indigenous persons; diabetes, substance abuse, comorbidity, lower income, locality, and fracture history were independently associated with an increased risk of fracture.ConclusionsThe observed paucity of data and suggestion of continent-specific differences indicate an urgent need for further research regarding indigenous status and fracture epidemiology and aetiology. Our findings also have implications for communities, governments and healthcare professionals to enhance the prevention of trauma-related fractures in indigenous persons, and an increased focus on modifiable lifestyle behaviours to prevent osteoporotic fractures in all populations.

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The post-fracture care gap among Canadian First Nations peoples: a retrospective cohort study

Cited by 14 publications

References 38 publications

The Cost of Osteoporosis, Osteopenia, and Associated Fractures in Australia in 2017

The Cost of Osteoporosis, Osteopenia, and Associated Fractures in Australia in 2017

Ethnic Differences in Bone Mass—Clinical Implications

Fractures in indigenous compared to non-indigenous populations: A systematic review of rates and aetiology

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