Applied Health Economics and Health Policy

, Volume 10, Issue 3, pp 163–173

Direct healthcare costs of osteoporosis-related fractures in managed care patients receiving pharmacological osteoporosis therapy


    • Amgen Inc.
    • One Amgen Center Drive
  • Jeffrey R. Curtis
    • University of Alabama at Birmingham
  • Jingbo Yu
    • HealthCore, Inc.
  • Jeffrey White
    • WellPoint Inc.
  • Bradley S. Stolshek
    • Amgen Inc.
  • Claire Merinar
    • Amgen Inc.
  • Akhila Balasubramanian
    • Amgen Inc.
  • Joel D. Kallich
    • Amgen Inc.
  • John L. Adams
    • RAND Corp.
  • Sally W. Wade
    • Wade Outcomes Research and Consulting
Original Research Article

DOI: 10.2165/11598590-000000000-00000

Cite this article as:
Viswanathan, H.N., Curtis, J.R., Yu, J. et al. Appl Health Econ Health Policy (2012) 10: 163. doi:10.2165/11598590-000000000-00000



Osteoporosis is a common condition and the economic burden of osteoporosis-related fractures is significant. While studies have reported the incremental or attributable costs of osteoporosis-related fracture, data on the economic impact of osteoporosis-related fractures in commercial health plan populations are limited.


To estimate the direct costs of osteoporosis-related fractures among pharmacologically treated patients in a large, commercially insured population between 2005 and 2008.


In this retrospective cohort study, patients were identified from a large, commercially insured population with integrated pharmacy and medical claims. Inclusion criteria were age 45–64 years; one or more osteoporosis medication claim(s) with first (index) claim between 1 January 2005 and 30 April 2008; and continuous insurance coverage for ≥12 months pre-index and ≥6 months post-index. Patients with pre-index Paget’s disease or malignant neoplasm; skilled nursing facility stay; combination therapy at index; or fracture ≤6 months post-index were excluded. A generalized linear model compared differences in 6-month pre-/post-event costs for patients with and without fracture. Propensity score weighting was used to ensure comparability of fracture and non-fracture patients. Generalized estimating equations accounted for repeated measures.


The study included 49 680 patients (2613 with fracture) with a mean (SD) age of 56.4 (4.7) years; 95.9% were female. Mean differences between pre- and post-event direct costs were $US14049 (95% CI 7670, 20 428) for patients with vertebral fractures, $US16 663 (95% CI 11690, 21636) for patients with hip fractures, and $US7582 (95% CI 6532, 8632) for patients with other fractures. After adjusting for covariates, osteoporosis-related fractures were associated with an additional $US9996 (95% CI 8838, 11154; p< 0.0001) in direct costs per patient across all fracture types during the 6 months following fracture.


Patients with osteoporosis-related fractures were found to incur nearly $US10 000 in estimated additional direct healthcare costs in the 6 months post-fracture, compared with patients with no fracture. Reduced fracture risk may lower associated direct healthcare costs.

Copyright information

© Springer International Publishing AG 2012