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Mortality, Independence in Living, and Re-fracture, One Year Following Hip Fracture in Canadians*

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1.To determine the one year mortality, institutionalization, and re-fracture rates following hip fractures in Canadians.
2.To compare post-fracture outcomes between those who fracture while living in institutions versus living in the community.
3.To compare Canadian data with that of other countries.

Methods: an observational study involved a cohort of 527 men and women aged 50 and older with hip fractures identified by ICD-9 codes. Subjects were contacted 12 months following acute care discharge between April 1, 1995 and March 21, 1996, from four hospitals in Hamilton Ontario. Data on mortality, place of residence, and re-fractures were obtained by telephone contact and searches of re-hospitalization records.

Results: data were obtained on 504 of the 527 Patients. Overall, 25.2% of patients died within one year. Among 399 Patients coming from the community, 20.5% died, 5.2% sustained another hip fracture and 19.0% (24.3% of survivors) were institutionalized. Among the 105 patients from institutions, only one returned to the community, 39.0% died, and 5.7% refractured a hip. Of those returning to the community, 62.4% had used home care services for a mean of 154 days (95% CI = 129,179). Osteoporosis was noted in the hospital records for only nine of 141 Patients (1.7%). None had bisphosphonates or hormone replacement recorded and only 25 (17.7%) had vitamin D or calcium recorded as discharge medications.

Interpretation: rates of mortality and loss of independence in living were similar to those found in other studies whereas hip re-fracture rates were higher (p<0.5). The frequency of diagnosis and preventative medications for osteoporosis was low in light of the risk of refracture. While outcomes may change with different health care systems, these findings may provide a framework in the Canadian context to direct further research and intervention to optimize patient care.