Incidence and risk factors of medical complications and direct medical costs after osteoporotic fracture among patients in China

Abstract

We analyzed the incidence of medical complications after osteoporotic fractures and estimated its risk factors and cost impacts. Osteoporotic fractures can result in lots of serious medical complications, which is associated with patients' baseline characteristics such as patients' disease history and significantly increased patients' direct medical costs.

Purpose: The purpose of the study is to investigate the incidence and identify the risk factors of medical complications after osteoporotic fracture, and quantify patients' economic burden.

Methods: Data were obtained from the Tianjin Urban Employee Basic Medical Insurance database (2009-2014). Patients aged ≥ 50 years, had ≥ 1 diagnoses of hip or vertebral fracture between 2010 and 2012, and continuously enrolled from 12 months before to 24 months after the first identified fracture were included. The incidence of medical complications was estimated within 12 months before and after fracture. Direct medical costs were measured and compared between patients with at least one medical complication and without any medical complications. Logistic regression was applied to identify risk factors for any medical complications.

Results: Three thousand seven hundred nineteen patients were identified; 45.0% had hip fracture, and 56.2% had vertebral fracture. After osteoporotic fracture, the accumulative incidence of the most common medical complications including constipation (25.6%, RR 1.38 [1.28, 1.48]), stroke (25.2%, 1.16 [1.09, 1.24]), pneumonia (17.0%, 1.55 [1.40, 1.73]), urinary tract infection (16.3%, 1.23 [1.12, 1.36]), and arrhythmia (11.8%, 1.39 [1.23, 1.56]) was significantly higher than that before fracture. Advanced age; male sex; retirement status; diagnosis of hypertension, chronic heart disease, cerebrovascular disease, hemiplegia, or Parkinson's disease; and higher direct medical costs at baseline were significant predictors of complications. The all-cause direct medical cost during 24-month follow-up was $5665. Medical complications significantly increased patients' direct medical costs.

Conclusions: Osteoporotic fractures led to amount of medical complications, which significantly increased patients' economic burden. Complications correlate to various factors such as patients' disease history.

Keywords: Complications; Economic burden; Hip fracture; Osteoporotic fracture; Risk factors; Vertebral fracture.

Fig. 1

Accumulative incidence of medical complications within 12 months before and after fracture among total osteoporotic fracture patients (N = 3719). The accumulative incidence of temporary respiratory insufficiency, diverticulitis, pulmonary edema, and infection of the central venous catheter was equal to zero, both in the 12 months before and after the index date. Difference = the incidence of complications within 12 months after fracture − the incidence of complications with 12 months before fracture. ^a95% confidence interval (CI) of the risk ratio. ^bCalculated using McNemar’s chi-squared test

Fig. 2

Accumulative incidence of medical complications within 12 months before and after fracture among hip fracture patients (n = 1675). The accumulative incidence of temporary respiratory insufficiency, diverticulitis, pulmonary edema, and infection of the central venous catheter was equal to zero, both in the 12 months before and after the index date. Difference = the incidence of complications within 12 months after fracture − the incidence of complications with 12 months before fracture. ^a95% confidence interval (CI) of the risk ratio. ^bCalculated using McNemar’s chi-squared test

Fig. 3

Accumulative incidence of medical complications within 12 months before and after fracture among vertebral fracture patients (n = 2089). The accumulative incidence of temporary respiratory insufficiency, diverticulitis, pulmonary edema, and infection of the central venous catheter was equal to zero, both in the 12 months before and after the index date. Difference = the incidence of complications within 12 months after fracture − the incidence of complications with 12 months before fracture. ^a95% confidence interval (CI) of the risk ratio. ^bCalculated using McNemar’s chi-squared test