Osteoporosis International

, Volume 5, Issue 6, pp 427–432 | Cite as

Direct clinical and welfare costs of osteoporotic fractures in elderly men and women

  • A. Randell
  • P. N. Sambrook
  • T. V. Nguyen
  • H. Lapsley
  • G. Jones
  • P. J. Kelly
  • J. A. Eisman
Original Article


Osteoporosis is an increasing health care problem in all aging populations, but overall direct costs associated with the total fracture burden of osteoporosis remain uncertain. We have examined direct costs associated with 151 osteoporotic fractures occurring between 1989 and 1992 in a large cohort of elderly men and women followed prospectively as part of the Dubbo Osteoporosis Epidemiology Study. The median cost of hospital treated fractures was $A10 511 per fracture and for fractures treated on an outpatient basis $A455 in 1992 Australian dollars. Femoral neck fractures were the most expensive fractures ($15984 median cost). There was no significant difference in costs between men and women for either hospital- or outpatient-treated fractures. Rehabilitation hospital costs comprised the largest proportion of costs (49%) for hospital-treated fractures. Community services comprised the major cost (40%) of outpatient-treated fractures. Univariate predictors of costs were quadriceps strength and bone density, although multivariate analysis showed quadriceps strength to be the best overall predictor of costs. The predicted annual treatment costs in Australia for atraumatic fractures occurring in subjects ⩾60 years was $A779 million or approximately $A44 million per million of population per annum. Estimated total osteoporotic fracture-related costs for the Australian population were much higher than previously reported. The majority of direct costs (95%) were incurred by hospitalized patients and related to hospital and rehabilitation costs. Extrapolation of these data suggests that the direct costs for hip fracture alone will increase approximately twofold in most Western countries by 2025. Improving the cost-effectiveness of treating osteoporotic fractures should involve reduced hospitalization and/or greater efficiency in community rehabilitation services. The costs of various approaches to osteoporosis prevention must be placed into the context of these direct costs and prevention should target men as well as women.


Direct costs Epidemiology Fractures Health economics Osteoporosis 


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  1. 1.
    Lindsay R, Dempster DW, Clemens T, Herrington BS, Wilt S. Incidence, cost and risk factor of fracture of the proximal femur in the USA. In: Christiansen C, Arnaud CD, Nordin BEC, Parfitt AM, Peck WA, Riggs BL, editors. Osteoporosis, Copenhagen: 1984:311–5.Google Scholar
  2. 2.
    Jones G, Nguyen TV, Sambrook P, Kelly P, Gilbert C, Eisman JA. Symptomatic fracture incidence in elderly men and women: the Dubbo Osteoporosis Epidemiology Study (DOES). Osteoporosis Int 1994;4:273–6.Google Scholar
  3. 3.
    Parry T. Health expenditure in Australia. Med J Aust 1992;156:592–4.Google Scholar
  4. 4.
    Holland E, Rogers L. Osteoporosis: impact on the elderly, societal concerns, and the role of radiology. Curr Probl Diagn Radiol 1989;18:46–61.Google Scholar
  5. 5.
    Kanis JA. The incidence of hip fracture in Europe. Osteoporosis Int 1993;Suppl 1:S10–5.Google Scholar
  6. 6.
    Nguyen TV, Sambrook PN, Kelly PJ, Jones G, Lord SR, Freund J, Eisman JA. Prediction of osteoporotic fractures by postural instability and bone density. BMJ 1993;307:1111–5.Google Scholar
  7. 7.
    Lord SR, Sambrook PN, Gilbert C, Kelly PJ, Nguyen TV, Webster I, Eisman JA. Postural stability, falls and fractures in the elderly: results from the Dubbo Osteoporosis Epidemiology Study. Med J Aust 1994;160:684–91.Google Scholar
  8. 8.
    Simons LA, McCallum J, Simons J, et al. The Dubbo Study: an Australian prospective community study of the health of the elderly. Aust NZ J Med 1990;20:783–9.Google Scholar
  9. 9.
    Cummings SR, Kelsey JL, Nevitt MC, O'Dowd KJ. Epidemiology of osteoporosis and osteoporotic fractures. Epidemiol Rev 1985;7:178–208.Google Scholar
  10. 10.
    Medicare Benefits Schedule Book. Commonwealth Department of Health, Housing, Local Government and Community Services, Australian Government Publishing Service, November 1993.Google Scholar
  11. 11.
    NSW Public Hospital Comparison Data 1991/2. NSW Health Department, 1993.Google Scholar
  12. 12.
    Personal communication from Lourdes Hospital Finance Department at the request of the authors.Google Scholar
  13. 13.
    MIMS Australia, 1992. Sydney: Promail Printing, 1992.Google Scholar
  14. 14.
    Manual of Resource Items and their Associated Costs. Commonwealth Department of Health, Housing and Community Services, Australian Government Printing Services, Canberra, August 1992.Google Scholar
  15. 15.
    Personal communications from local administrative bodies for each organisation.Google Scholar
  16. 16.
    SAS Institute. SAS/STAT user's guide. Cary, NC: SAS Institute, 1990.Google Scholar
  17. 17.
    Cooper C, Campion G, Melton LJ. Hip fractures in the elderly: a world-wide projection. Osteoporosis Int 1992;2:285–9.Google Scholar
  18. 18.
    Sernbo I, Johnell O. Consequences of a hip fracture: a prospective study over 1 year. Osteoporosis Int 1993;3:148–53.Google Scholar
  19. 19.
    Kanis JA, Pitt FA. Epidemiology of osteoporosis. Bone 1992;13:S7–15.Google Scholar
  20. 20.
    Clark AP, Schuttinga JA. Targeted estrogen/progestogen replacement therapy for osteoporosis: calculation of health care cost savings. Osteoporosis Int 1992;2:195–200.Google Scholar
  21. 21.
    Cheung AP, Wren BG. A cost effectiveness analysis of hormone replacement therapy in menopause. Med J Aust 1992;156:312–6.Google Scholar
  22. 22.
    Geelhoed E, Harris A, Prince R. Economic evaluation of strategies to reduce osteoporotic fractures in women: a Markov modelling approach. In: Selby Smith C, editor. Proceedings of the 14th Australian Conference of Health Economists. Monash: Graduate School Management, 1992:1–22.Google Scholar
  23. 23.
    Cummings SR, Rubin SM, Black D. The future of hip fractures in the United States. Clin Orthop 1990;252:163–6.Google Scholar
  24. 24.
    Tosteson AN, Rosenthal DI, Melton JL, Weinstein MC. Cost effectiveness of screening perimenopausal white women for osteoporosis: bone densitometry and hormone replacement therapy. Ann Intern Med 1990;113:594–603.Google Scholar
  25. 25.
    Levy E. Cost analysis of osteoporosis related to untreated menopause. Clin Rheumatol 1989;8(Suppl 2):76–82.Google Scholar
  26. 26.
    Phillips S, Fox N, Jacobs J, Wright WE. The direct medical costs of osteoporosis for American women aged 45 and older. Bone 1988;9:271–9.Google Scholar
  27. 27.
    Weinstein MC, Schiff I. Cost-effectiveness of hormone replacement therapy in the menopause. Obst Gynecol Surg 1983;38:445–55.Google Scholar
  28. 28.
    Crowley S, Antioch K, Carter R, Waters A, Conway L, Mathers C. Cost of diet-related disease in Australia. Joint report from Australian Institute of Health and Welfare and the National Health and Medical Research Council, 1992.Google Scholar
  29. 29.
    Norris RJ. Medical costs of osteoporosis. Bone 1992;13:S11–6.Google Scholar

Copyright information

© European Foundation for Osteoporosis 1995

Authors and Affiliations

  • A. Randell
    • 2
  • P. N. Sambrook
    • 2
  • T. V. Nguyen
    • 2
  • H. Lapsley
    • 1
  • G. Jones
    • 2
  • P. J. Kelly
    • 2
  • J. A. Eisman
    • 2
  1. 1.School of Health Service ManagementUniversity of New South WalesSydneyAustralia
  2. 2.Sambrook, Bone and Mineral Research Division, Garvan Institute of Medical ResearchSt. Vincent's HospitalDarlinghurstAustralia

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