Osteoporosis International

, Volume 14, Issue 5, pp 383–388 | Cite as

Cost-equivalence of different osteoporotic fractures

  • L. J. MeltonIIIEmail author
  • S. E. Gabriel
  • C. S. Crowson
  • A. N. A. Tosteson
  • O. Johnell
  • J. A. Kanis
Original Article



Among 985 Olmsted County, Minnesota, residents who experienced an osteoporotic fracture (distal forearm, humerus, clavicle/scapula/sternum, ribs, vertebrae, pelvis, hip, other femur or tibia/fibula [the latter in women only]), we estimated the incremental cost of direct medical care in the following year compared with age- and sex-matched controls without a fracture randomly sampled from the same community.


The overall median incremental (case minus control) cost in the succeeding year was $2390, with a particularly high incremental cost for hip fractures ($11,241). There was fair concordance between the incremental cost of the different fractures, relative to hip fracture alone, and the previously published disutility associated with each fracture type relative to hip fracture. Overall, the incremental cost for all osteoporotic fractures combined was 46% greater than that for hip fractures alone in women and 47% greater in men. This is consistent with the earlier report that overall morbidity from all osteoporotic fractures combined is 47% and 39% greater in women and men, respectively, than the morbidity attributable solely to hip fractures.


These data lend support to the notion that other osteoporotic fractures can be quantified relative to hip fracture on the basis of their cost, as well as their morbidity and mortality. This may simplify health economic analyses by allowing all fracture outcomes to be modeled relative to hip fractures (i.e., hip fracture 'equivalents') and will provide a more comprehensive assessment of osteoporosis outcomes than is possible by focusing only on hip fractures.


Cost analysis Epidemiology Forearm fracture Hip fracture Osteoporosis Vertebral fracture 



We wish to thank Megan Maurer for help with the data analysis and Mary Roberts for assistance in preparing the manuscript.


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Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2003

Authors and Affiliations

  • L. J. MeltonIII
    • 1
    • 5
    Email author
  • S. E. Gabriel
    • 1
  • C. S. Crowson
    • 1
  • A. N. A. Tosteson
    • 2
  • O. Johnell
    • 3
  • J. A. Kanis
    • 4
  1. 1.Department of Health Sciences ResearchMayo Clinic and Mayo FoundationRochesterUSA
  2. 2.Center for Evaluative Clinical SciencesDartmouth Medical SchoolHanoverUSA
  3. 3.Department of OrthopaedicsMalmö General HospitalMalmöSweden
  4. 4.WHO Collaborating Centre for Metabolic Bone DiseasesUniversity of Sheffield Medical SchoolSheffieldUK
  5. 5.Division of EpidemiologyMayo ClinicRochesterUSA

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