Economic Burden of Osteoporosis-Related Fractures in the US Medicare Population

Abstract

Background: Osteoporosis-related fractures are an important public health burden.

Objective: To examine health care costs in Medicare patients with an osteoporosis-related fracture.

Methods: Medicare fee-for-service members with an osteoporosis-related fracture between January 1, 2010, to September 30, 2014 were included. A nonfracture comparator group was selected by propensity score matching. Generalized linear models using a gamma distribution were used to compare costs between fracture and nonfracture cohorts.

Results: A total of 885 676 Medicare beneficiaries had fracture(s) and met inclusion criteria. Average age was 80.5 (±8.4) years; 91% were White, and 94% female. Mean all-cause costs were greater in the fracture vs nonfracture cohort ($47 163.25 vs $16 034.61) overall and for men ($52 273.79 vs $17 352.68). The highest mean costs were for skilled nursing facility ($29 216), inpatient costs ($24 190.19), and hospice care ($20 996.83). The highest incremental costs versus the nonfracture cohort were for hip ($71 057.83 vs $16 807.74), spine ($37 543.87 vs $16 860.49), and radius/ulna ($24 505.27 vs $14 673.86). Total medical and pharmacy costs for patients who experienced a second fracture were higher compared with those who did not ($78 137.59 vs $44 467.47). Proportionally more patients in the fracture versus nonfracture cohort died (18% vs 9.3%), with higher death rates among men (20% vs 11%).

Conclusion and relevance: The current findings suggest a significant economic burden associated with fractures. Early identification and treatment of patients at high risk for fractures is of paramount importance for secondary prevention and reduced mortality.

Keywords: Medicare; cost; fracture; male; osteoporosis.

Figure 1.

Study design. ^a The preindex date is ≥1 year prior to index date (as early as January 1, 2006, for some patients) and is not the same for all patients. ^b Index date (date of fracture or comparable start of follow-up in the nonfracture cohort) could occur any time between January 1, 2010, and September 30, 2014, and is not the same for all patients. ^c Postindex period (follow-up time after index fracture or comparable start of follow-up in the nonfracture cohort) spans from the day after the index date up to 12 months postindex and is not the same for all patients.

Figure 2.

Health care resource utilization, percentage of patients: A. Health care costs by cohort (preindex and 12-month follow-up). B. All-cause and osteoporosis-related cost by fracture type. Abbreviations: OP, Osteoporosis. ^a Total medical costs include carrier, durable medical equipment, home health, hospice, inpatient, outpatient, and skilled nursing facility. ^b The nonfracture cohort was selected by 1:1 propensity score matching for each index year during the identification period. ^c Costs were classified as osteoporosis-related if there was a diagnosis of osteoporosis or fracture in any position on the medical claim.