Osteoporosis International

, Volume 16, Issue 1, pp 78–85 | Cite as

One year outcomes and costs following a vertebral fracture

  • R. Lindsay
  • R. T. Burge
  • D. M. Strauss
Original Article


Vertebral fractures are believed to be important predictors for future vertebral and other fractures, leading to at least a 4- to 5-fold increase in the risk of subsequent fractures. However, little is known about their associated near-term costs. The purpose of this study was to quantify the subsequent fracture and cost outcomes emanating from patients with an incident vertebral fracture. A probabilistic decision analysis model was developed to estimate the expected cost of all subsequent fractures. We ran Kaplan-Meier time-to-event models on placebo patients in risedronate’s pivotal phase III clinical trial data to determine the cumulative incidence or probabilities of all fractures within one year of an incident vertebral fracture. Unit costs for health care payers in the USA and Sweden for vertebral, hip, other, and forearm/wrist fractures were multiplied by fracture probabilities to generate the expected costs of new fractures within one year of incident vertebral fractures. Our analysis found that that 26.1% of vertebral fracture patients with a mean age of 74 years refractured within 1 year (vertebral 17.4%; hip 3.6%; “other” 3.5%; forearm/wrist 1.6%). The calculated medical costs for those patients who refracture within 1 year was $5906 and €3670 for the USA and Sweden, respectively, while the weighted average cost across all patients (refracture and non-fracture) within a year of their incident fracture was $1541 (USA) and €958 (Sweden). These results suggest that therapies with proven, rapid efficacy may offer important economic value to healthcare payers, providers and patients.


Costs Osteoporosis Outcomes Refracture Vertebral fractures 



This study was supported by the Alliance for Better Bone Health (Aventis Pharma and Procter & Gamble Pharmaceuticals).

Conflict of interest:

No information supplied.


  1. 1.
    Ross PD, Davis JW, Epstein RS, Wasnich RD (1991) Pre-existing fractures and bone mass predict vertebral fracture incidence in women. Ann Int Med 114:919–923Google Scholar
  2. 2.
    Ross PD, Genant HK, Davis JW, Miller PD, Wasnich RD (1993) Predicting vertebral fracture incidence from prevalent fractures and bone mass density among non-black, osteoporotic women. Osteoporos Int 3:120–126PubMedGoogle Scholar
  3. 3.
    Black DM, Arden NK, Palermo L, Pearson M, Cummings SR (1999) Prevalent vertebral deformities predict hip fractures and new vertebral deformities but not wrist fractures. J Bone Miner Res 14:821–828PubMedGoogle Scholar
  4. 4.
    Kotowicz M, Melton LJ, Cooper C, Atkinson EJ, O’Fallon WM, Riggs BL (1994) Risk of hip fracture in women with vertebral fracture. J Bone Miner Res 5:599–605Google Scholar
  5. 5.
    Johnell O, Kanis JA, Oden A, Sernbo I et al. (2004) Fracture risk following an osteoporotic fracture. Osteoporos Int 15:175–179.CrossRefPubMedGoogle Scholar
  6. 6.
    Melton LJ, Atkinson EJ, Cooper C, O’Fallon W, Riggs BL (1999) Vertebral fractures predict subsequent fractures. Osteoporos Int 10:214–221CrossRefPubMedGoogle Scholar
  7. 7.
    Klotzbuecher CM, Ross PD, Landsman PB, Abbott TA, Berger M (2000) Patients with prior fractures have an increased risk of future fractures: a summary of the literature and statistical synthesis. J Bone Miner Res 15:721–739PubMedGoogle Scholar
  8. 8.
    van Staa TP, Leufkens HG, Cooper C (2002) Does a fracture at one site predict later fractures at other sites? A British cohort study. Osteoporos Int 13:624–629CrossRefGoogle Scholar
  9. 9.
    Cooper C, Atkinson EJ, O’Fallon W, Melton LJ (1992) Incidence of clinically diagnosed vertebral fractures: a population-based study in Rochester, Minnesota: 1985–1989. J Bone Miner Res 7:221–227PubMedGoogle Scholar
  10. 10.
    Clark AP, Schuttinga JA (1992) Targeted estrogen/progestogen replacement therapy for osteoporosis: calculation of health care cost savings. Osteoporos Int 2:195–200PubMedGoogle Scholar
  11. 11.
    Gehlbach SH, Bigelow C, Heimisdottir M, May S, Walker M, Kirkwood JR (2000) Recognition of vertebral fracture in a clinical setting. Osteoporos Int 11:577–582CrossRefPubMedGoogle Scholar
  12. 12.
    Burge RT, Puleo E, Gehlbach S, Worley D, Klar J (2002) Inpatient hospital and post-acute care for vertebral fractures in women. Value-In-Health 5:301–311Google Scholar
  13. 13.
    Gehlbach SH, Burge RT, Puleo E, Klar J (2003) Hospital care of osteoporosis-related vertebral fractures. Osteoporos Int 14:53–60PubMedGoogle Scholar
  14. 14.
    Ray NF, Chan JK, Thamer M, Melton LJ (1997) Medical expenditures for the treatment of osteoporotic fractures in the United States in 1995: report from the National Osteoporosis Foundation. J Bone Miner Res 12:24–35PubMedGoogle Scholar
  15. 15.
    Phillips S, Fox N, Jacobs J, Wright W (1988) The Direct medical costs of osteoporosis for American women aged 45 and older, 1986. Bone 9:271–279PubMedGoogle Scholar
  16. 16.
    Chrischilles E, Shireman T, Wallace R (1994) Costs and health effects of osteoporotic fractures. Bone 15:377–386PubMedGoogle Scholar
  17. 17.
    US Congress Office of Technical Assistance (1994) Hip fracture outcomes in people age fifty and over: background paper. US Government Printing Office, Washington, D.C.Google Scholar
  18. 18.
    Decision Analysis by TreeAge (DATA), Version 3.5.4. TreeAge Software, Inc. Williamstown, Mass., USAGoogle Scholar
  19. 19.
    Harris ST, Watts NB, Genant HK et al. (1999) Effects of risedronate treatment on vertebral and nonvertebral fractures in women with postmenopausal osteoporosis: a randomized controlled trial. JAMA 280:2077–2082Google Scholar
  20. 20.
    Reginster J, Minne HW, Sorensen OH et al. (2000) Randomized trial of the effects of risedronate on vertebral fractures in women with established postmenopausal osteoporosis. Vertebral Efficacy with Risedronate Therapy (VERT) Study Group. Osteoporos Int 11:83–91PubMedGoogle Scholar
  21. 21.
    McClung MR, Geusens P, Miller PD et al. (2001) Effect of risedronate on the risk of hip fracture in elderly women. N Engl J Med 344:333–340CrossRefPubMedGoogle Scholar
  22. 22.
    Lindsay R, Silverman SL, Cooper C, Hanley DA, Barton I, Broy SB, Licata A, Benhamou L, Geusens P, Flowers K, Stracke H, Seeman E (2001) Risk of new vertebral fracture in the year following a fracture. JAMA 285:320–323PubMedGoogle Scholar
  23. 23.
    National Osteoporosis Foundation (1998) Osteoporosis: review of the evidence for prevention, diagnosis and treatment and cost-effective analysis. Osteoporos Int Supplement 4:s1–s88Google Scholar
  24. 24.
    Nationwide Inpatient Sample, Release 6 (1997) Healthcare Cost and Utilization Project, Agency for Healthcare Research and Quality, Rockville, Maryland, USAGoogle Scholar
  25. 25.
    Hoerger T, Downs K, Lakshmanan M et al. (1999) Healthcare use among US women aged 45 and older: total costs and costs for selected postmenopausal health risks. J Women’s Health Gender-Based Med 8:1077–1089Google Scholar
  26. 26.
    Jacobsen SJ, Cooper C, Gottlieb MS et al. (1992) Hospitalization with vertebral fracture among the aged: a national population-based study, 1986–1989. Epidemiology 3:515–518PubMedGoogle Scholar
  27. 27.
    Ankjaer-Jensen A, Johnell O (1996) Prevention of osteoporosis: cost-effectiveness of different pharmaceutical treatments. Osteoporos Int 6:265–275PubMedGoogle Scholar
  28. 28.
    Cooper C, O’Neill T, Silman AJ (1993) European Vertebral Osteoporosis Study Group. The epidemiology of vertebral fractures. Bone 14:S89–97PubMedGoogle Scholar
  29. 29.
    Holbrook TL et al. (1984) The frequency of occurrence, impact, and cost of selected musculoskeletal conditions in the US. American Academy of Orthopedic Surgeons, ChicagoGoogle Scholar
  30. 30.
    Zethraeus N, Strömberg L, Jönsson B, Svensson O, Öhlén G (1997) The cost of a hip fracture. Estimates for 1709 patients in Sweden. Acta Orthop Scand 68:13–17PubMedGoogle Scholar
  31. 31.
    Zethraeus N, Borgström F, Johnell O, Kanis J, Önnby K, Jönsson B (2002) Costs and quality of life associated with osteoporosis related fractures—results from a Swedish survey. SSE/EFI Working Paper Series in Economics and Finance, No 512, OctoberGoogle Scholar
  32. 32.
    Gabriel SE, Tosteson ANA, Leibson CL et al. (2002) Direct medical costs attributable to osteoporotic fractures. Osteoporos Int 13:323–330CrossRefGoogle Scholar
  33. 33.
    De Laet C, van Hout BA, Burger H et al. (1999) Incremental cost of medical care after hip fracture and first vertebral fracture: the Rotterdam study. Osteoporos Int 10:66–72CrossRefPubMedGoogle Scholar
  34. 34.
    Tosteson ANA, Gabriel SE, Grove MR et al. (2001) Impact of hip and vertebral fractures on quality-adjusted life years. Osteoporos Int 12:1042–1049CrossRefPubMedGoogle Scholar
  35. 35.
    Kanis JA, Johnell O, Oden A, Borgstrom F, Zethraeus N, De Laet C, Jonsson B (2004) The risk of vertebral fractures in Sweden. Osteoporos Int 15:20–26CrossRefPubMedGoogle Scholar

Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2004

Authors and Affiliations

  • R. Lindsay
    • 1
  • R. T. Burge
    • 2
    • 3
  • D. M. Strauss
    • 2
  1. 1.Helen Hayes HospitalWest HaverstrawUSA
  2. 2.Department of Epidemiology and PharmacoeconomicsProcter & Gamble PharmaceuticalsMasonUSA
  3. 3.School of Public HealthBoston UniversityBostonUSA

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