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

Archives of Osteoporosis, Feb 2018

Ruiqi Liu, Aijun Chao, Ke Wang, Jing Wu

A PDF file should load here. If you do not see its contents the file may be temporarily unavailable at the journal website or you do not have a PDF plug-in installed and enabled in your browser.

Alternatively, you can download the file locally and open with any standalone PDF reader:

https://link.springer.com/content/pdf/10.1007%2Fs11657-018-0429-5.pdf

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

Archives of Osteoporosis Incidence and risk factors of medical complications and direct medical costs after osteoporotic fracture among patients in China Ruiqi Liu 0 1 2 Aijun Chao 0 1 2 Ke Wang 0 1 2 Jing Wu 0 1 2 0 Lilly Suzhou Pharmaceutical Co. Ltd. , Shanghai 200021 , China 1 Tianjin Hospital , Tianjin 300072 , China 2 School of Pharmaceutical Science and Technology, Tianjin University , No. 92 Weijin Rd., Nankai District, Tianjin 300072 , China Summary 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. Osteoporotic fracture; Hip fracture; Vertebral fracture; Complications; Risk factors; Economic burden Introduction Osteoporosis is the most common systemic and metabolic skeletal disease, characterized by low bone mass, deterioration of bone tissue, disruption of bone architecture, compromised bone strength, and increased risk of fracture [ 1 ]. Osteoporotic fragility fractures, predominantly vertebral, hip, proximal humeral, and distal forearm fractures, are clinical consequences of osteoporosis [ 1 ]. Approximately 40–50% of females and 13–22% of males sustained at least one osteoporotic fracture over the course of their entire life [ 2 ]. The number of patients with any osteoporotic fracture in China in 2010 was 2.33 million, a number that is projected to increase to 5.99 million by 2050 [ 3 ]. Previous studies have indicated that osteoporotic fractures are significantly associated with a higher risk of subsequent fracture and excess mortality [ 4, 5 ]. The accumulative incidence of subsequent fracture within 5 years after an initial osteoporotic fracture was 24% in females and 20% in males, whereas the 5-year accumulative all-cause mortality rate was 24% in females and 27% in males, respectively [4]. Furthermore, fragility fractures could also significantly lower patients’ health-related quality of life, and this loss was sustained for at least 18 months for hip and vertebral fractures [ 5 ]. In addition, the economic strain on patients and the healthcare system resulting from osteoporotic fractures are heavy. The relevant annual treatment costs of osteoporotic fracture were calculated at $9.45 billion, and it will increase to roughly $25.43 billion by 2050 in China [ 3 ]. One study conducted in western China indicated that the average direct medical cost for osteoporotic fracture patients was approximately RMB 17007 ($2699) per year per patient; the economic burden attributed to hip fracture was highest, followed by vertebral fracture [ 6 ]. Previous studies showed that osteoporotic fractures are consistently followed by a large number of medical complications, such as cardiac diseases, venous thromboembolism, pneumonia, urinary tract complications, gastrointestinal tract blee (...truncated)


This is a preview of a remote PDF: https://link.springer.com/content/pdf/10.1007%2Fs11657-018-0429-5.pdf

Ruiqi Liu, Aijun Chao, Ke Wang, Jing Wu. Incidence and risk factors of medical complications and direct medical costs after osteoporotic fracture among patients in China, Archives of Osteoporosis, 2018, pp. 12, Volume 13, Issue 1, DOI: 10.1007/s11657-018-0429-5