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)