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. 2009 Apr;24(4):681-92.
doi: 10.1359/jbmr.081226.

Interstate variation in the burden of fragility fractures

Alison B King  1 , Anna N A Tosteson, John B Wong, Daniel H Solomon, Russel T Burge, Bess Dawson-Hughes
Affiliations

Interstate variation in the burden of fragility fractures

Alison B King et al. J Bone Miner Res. 2009 Apr.

Abstract

Demographic differences may produce interstate variation in the burden of osteoporosis. We estimated the burden of fragility fractures by race/ethnicity, age, sex, and service site across five diverse and populous states. State inpatient databases for 2000 were used to describe hospital fracture admissions, and a Markov decision model was used to estimate annual fracture incidence and cost for populations >or=50 yr of age for 2005-2025 in Arizona (AZ), California (CA), Florida (FL), Massachusetts (MA), and New York (NY). In 2000, mean hospital charges for incident fractures varied 1.7-fold across states. For hip fracture, mean charges ranged from $16,700 (MA) to $29,500 (CA), length of stay from 5.3 (AZ) to 8.9 days (NY), and discharge rate to long-term care from 43% (NY) to 71% (CA). In 2005, projected fracture incidence rates ranged from 199 (CA) to 266 (MA) per 10,000. Total cost ranged from $270 million (AZ) to $1,434 million (CA). Men accounted for 26-30% of costs. Across states, hip fractures constituted on average 77% of costs; "other" fractures (e.g., leg, arm), 10%; pelvic, 6%; vertebral, 5%; and wrist, 2%. By 2025, Hispanics are projected to represent 20% of fractures in AZ and CA and Asian/Other populations to represent 27% of fractures in NY. In conclusion, state initiatives to prevent fractures should include nonwhite populations and men, as well as white women, and should address fractures at all skeletal sites. Interstate variation in service utilization merits further evaluation to determine efficient and effective disease management strategies.

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Figures

FIG. 1
FIG. 1
(A) Number of hospital admissions per 10,000 men and women ≥50 yr of age. (B) Mean hospital charge (bars represent SDs). (C) Mean length of hospital stay. (D) Percentage of patients discharged to long-term care (LTC) facilities for men and women ≥50 yr of age admitted to hospitals for fragility fracture in 2000. (U.S data are for hospital admissions in 2001.)
FIG. 2
FIG. 2
Distribution of estimated fracture costs by race/ethnicity in 2005 and 2025, by state.
See this image and copyright information in PMC

References

    1. National Osteoporosis Foundation. America's Bone Health: The State of Osteoporosis and Low Bone Mass. Washington, DC, USA: National Osteoporosis Foundation; 2002.
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    1. U.S. Census Bureau. 2004. Projected population of the United States, by race and Hispanic origin: 2000-2050. U.S. Interim Projections by Age, Sex, Race, and Hispanic Origin. Available online at http://www.census.gov/ipc/www/usinterimproj/natprojtab01a.pdf. Accessed October 2, 2007.
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