Osteoporosis International

, Volume 18, Issue 5, pp 649–657 | Cite as

Hospitalised osteoporotic vertebral fractures in Spain: Analysis of the national hospital discharge registry

  • C. BouzaEmail author
  • T. López
  • M. Palma
  • J. M. Amate
Original Article



This population-based study reveals clinical and epidemiologic characteristics of hospitalised osteoporosis-related vertebral fractures and indicates an association with a substantial hospital burden in Spain. These data provide a basis for assessing the impact of these fractures on the Spanish health-care system and to estimate future care requirements.


Vertebral fractures (VF) are recognised as the most frequent complication of osteoporosis. Our objective was to determine the clinico-epidemiological characteristics and health-care burden of hospitalised VF in Spain.


From the 2002 National Hospital Discharge Register, records for all osteoporosis-related VF in the Spanish population aged ≥30 years and over were retrieved. Diagnostic categories included the ICD-9-CM codes 805 and 733.xx. Population data were drawn from the National Statistics Institute.


In total, 7,100 records were eligible for analysis. According to Deyo-adapted Charlson index, 62% of cases had no associated comorbidity. VF were the cause of hospitalisation in 52% of cases. Overall in-hospital mortality was 3.5%. Men had higher adjusted mortality than women. Mean hospital stay was 11.4±0.2 days. Identified cases amounted to a hospitalisation rate of 2.76 cases per 10,000 population aged ≥30 years. Direct inpatient hospital costs exceeded €41million and accounted for 0.078% of Spanish expenditure on hospitalisations and specialised care in 2002.


The national discharge database reveals epidemiological features of hospitalised osteoporosis-attributable VF and indicates an association with a substantial hospital burden in Spain. Our data provide a basis for assessing the impact of these fractures on the Spanish health-care system and to estimate future care requirements.


Administrative data Health services research Osteoporosis Vertebral fractures 



This study was supported by the Spanish National I+D Program (SEC 2001–0138). C. Bouza is the recipient of a post-doctoral contract from the Dirección General de Universidades e Investigación, Consejería de Educación de la Comunidad de Madrid (n° 02/0381/2002).


  1. 1.
    European Commission. Directorate-General for Employment, Industrial Relations and Social Affairs. Directorate V/F.2 (1998) Report on Osteoporosis in the European Community. Action for prevention.
  2. 2.
    Cooper C, Melton LJ III (1992) Vertebral fractures: how large is the silent epidemic? BMJ 304:793–794PubMedCrossRefGoogle Scholar
  3. 3.
    The European Prospective Osteoporosis Study (EPOS) Group (2002) Incidence of vertebral fracture in Europe: results from the European Prospective Osteoporosis Study (EPOS) J Bone Miner Res 17:716–724CrossRefGoogle Scholar
  4. 4.
    Naves Diaz M, Diaz Lopez JB, Gomez Alonso C et al (2000) Study of incidence of osteoporotic fractures in a cohort of individuals older than 50 years from Asturias, Spain, after a 6 year follow-up period. Med Clin 115:650–653Google Scholar
  5. 5.
    Silverman SL (1992) The clinical consequences of vertebral compression fracture. Bone 13:S27–S31PubMedCrossRefGoogle Scholar
  6. 6.
    Kado DM, Browner WS, Palermo L et al (1999) Vertebral fractures and mortality in older women: a prospective study. Study of Osteoporotic Fractures Research Group. Arch Intern Med 159:1215–1220PubMedCrossRefGoogle Scholar
  7. 7.
    Cooper C, Atkinson EJ, Jacobsen SJ et al (1993) Population based study of survival after osteoporotic fractures. Am J Epidemiol 137:1001–1005PubMedGoogle Scholar
  8. 8.
    Naves M, Diaz-Lopez JB, Gomez C et al (2003) The effect of vertebral fracture as a risk factor for osteoporotic fracture and mortality in a Spanish population. Osteoporos Int 14:520–524PubMedCrossRefGoogle Scholar
  9. 9.
    Cockerill W, Lunt M, Silman AJ et al (2004) Health-related quality of life and radiographic vertebral fracture. Osteoporos Int 15:113–119PubMedCrossRefGoogle Scholar
  10. 10.
    O’Neill TW, Cockerill W, Matthis C et al (2004) Back pain, disability, and radiographic vertebral fracture in European women: a prospective study. Osteoporos Int 15:760–765PubMedCrossRefGoogle Scholar
  11. 11.
    Melton LJ 3rd, Thamer M, Ray NF et al (1997) Fractures attributable to osteoporosis: report from the National Osteoporosis Foundation. J Bone Miner Res 12:16–23PubMedCrossRefGoogle Scholar
  12. 12.
    Gehlbach SH, Bigelow C, Heimisdottir M et al (2000) Recognition of vertebral fractures in a clinical setting. Osteoporos Int 11:577–582PubMedCrossRefGoogle Scholar
  13. 13.
    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
  14. 14.
    Johnell O, Gullberg B, Kanis JA (1997) The hospital burden of vertebral fracture in Europe: a study of National Register Sources. Osteoporos Int 7:138–144PubMedCrossRefGoogle Scholar
  15. 15.
    Johnell O (2003) Economic implication of osteoporotic spine disease: cost to society. Eur Spine J 12:S168–S169PubMedCrossRefGoogle Scholar
  16. 16.
    Lippuner K, Golder M, Greiner R (2005) Epidemiology and direct medical costs of osteoporotic fractures in men and women in Switzerland. Osteoporos Int 16:S8–S17PubMedCrossRefGoogle Scholar
  17. 17.
    Puffer S, Torgerson DJ, Sykes D et al (2004) Health care costs of women with symptomatic vertebral fractures. Bone 35:383–386PubMedCrossRefGoogle Scholar
  18. 18.
    Johnell O, Kanis JA, Jonsson B et al (2005) The burden of hospitalised fractures in Sweden. Osteoporos Int 16:222–228PubMedCrossRefGoogle Scholar
  19. 19.
    Roos LL, Fedson DS, Roberts JD et al (1996) Reminding and monitoring: new uses of administrative data for preventive care. Health Manage Forum 9:30–36CrossRefGoogle Scholar
  20. 20.
    Robinson JR, Young TK, Roos LL et al (1997) Estimating the burden of disease. Comparing administrative data and self-reports. Med Care 35:932–947PubMedCrossRefGoogle Scholar
  21. 21.
    Charlson ME, Pompei P, Ales S et al (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chron Dis 40:373–383PubMedCrossRefGoogle Scholar
  22. 22.
    Deyo RA,Cherkin DC, Ciol MA (1992) Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases. J Clin Epidemiol 45:613–619PubMedCrossRefGoogle Scholar
  23. 23.
    Librero J, Peiró S, Ordiñana R (1999) Chronic comorbidity and outcomes of hospital care: length of stay, mortality and readmission at 30 and 365 days. J Clin Epidemiol 52:171–179PubMedCrossRefGoogle Scholar
  24. 24.
    Health Information Institute. Ministry of Health and Consumer Affairs. (Accessed:10-05-2006)
  25. 25.
    Papaioannou A, Watts NB, Kendler DL et al (2002) Diagnosis and management of vertebral fractures in elderly adults. Am J Med 113:220–228PubMedCrossRefGoogle Scholar
  26. 26.
    Melton LJI (1997) Epidemiology of spinal osteoporosis. Spine 22:S2–S11CrossRefGoogle Scholar
  27. 27.
    Vestergaard P, Rejnmark L, Mosekilde L (2005) Osteoporosis is markedly underdiagnosed: a nationwide study from Denmark. Osteoporos Int 16:134–141PubMedCrossRefGoogle Scholar
  28. 28.
    Ettinger B, Black DM, Nevitt MC et al (1992) Contribution of vertebral deformities to chronic back pain and disability. The Study of Osteoporotic Fractures Research Group. J Bone Miner Res 7:449–456PubMedCrossRefGoogle Scholar
  29. 29.
    Delmas PD, van de Langerijt L, Watts NB et al (2005) Underdiagnosis of vertebral fractures is a worldwide problem: the IMPACT study. J Bone Miner Res 20:557–563PubMedCrossRefGoogle Scholar
  30. 30.
    Jalava T, Sarna S, Pylkkanen L et al (2003) Association between vertebral fracture and increased mortality in osteoporotic patients. J Bone Miner Res 18:1254–1259PubMedCrossRefGoogle Scholar
  31. 31.
    Ensrud KE, Thompson DE, Cauley JA et al (2000) Prevalent vertebral deformities predict mortality and hospitalization in older women with low bone mass. Fracture Intervention Trial Research Group. J Am Geriatr Soc 48:241–249PubMedGoogle Scholar
  32. 32.
    Kanis JA, Oden A, Johnell O et al (2004) Excess mortality after hospitalisation for vertebral fractures. Osteoporos Int 15:108–112PubMedCrossRefGoogle Scholar
  33. 33.
    Papaioannou A, Adachi JD, Parkinson W et al (2001) Lengthy hospitalization associated with vertebral fractures despite control for comorbid conditions. Osteoporos Int 12:870–874PubMedCrossRefGoogle Scholar
  34. 34.
    Kanis JA, Johnell O, Oden A et al (2002) Intervention thresholds for Osteoporosis. Bone 31:26–31PubMedCrossRefGoogle Scholar
  35. 35.
    Kanis JA, Johnell O, Oden A et al (2004) The risk and burden of vertebral fractures in Sweden. Osteoporos Int 15:20–26PubMedCrossRefGoogle Scholar
  36. 36.
    Ray NF, Chan JK, Thamer M et al (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 12:24–35PubMedCrossRefGoogle Scholar
  37. 37.
    Gabriel SE, Tosteson AN, Leibson CL et al (2002) Direct medical costs attributable to osteoporotic fractures. Osteoporos Int 13:323–330PubMedCrossRefGoogle Scholar
  38. 38.
    Borgstrom F, Zethraeus N, Johnell O et al (2006) Costs and quality of life associated with osteoporosis-related fractures in Sweden. Osteoporos Int 17:637–650PubMedCrossRefGoogle Scholar
  39. 39.
    Schwenkglenks M, Lippuner K, Hauselmann HJ et al (2005) A model of osteoporosis impact in Switzerland 2000–2020. Osteoporos Int 16:659–671PubMedCrossRefGoogle Scholar
  40. 40.
    Ley Orgánica 15/1999 de 13 de Diciembre de Protección de Datos de Carácter personal. Boletín Oficial del Estado n° 298, de 14-12-1999, pp 43088–43099Google Scholar
  41. 41.
    Ley 41/2002, de 14 noviembre, ley básica reguladora de la autonomía del paciente y de derechos y obligaciones en materia de información y documentación clínica. Boletín Oficial del Estado n° 274, de 15-11-2002, pp 40126–40132. Accessible at
  42. 42.
    Wilchesky M, Tamblyn RM, Huang A (2004) Validation of diagnostic codes within medical services claims. J Clin Epidemiol 57:131–141PubMedCrossRefGoogle Scholar
  43. 43.
    Delmas PD, Genant HK, Crans GG et al (2003) Severity of prevalent vertebral fractures and the risk of subsequent vertebral and nonvertebral fractures: results from the MORE trial. Bone 33:522–532PubMedCrossRefGoogle Scholar
  44. 44.
    O’Neill TW, Marsden D, Matthis C et al (1995) Survey response rates: national and regional differences in a European multicentre study of vertebral osteoporosis. J Epidemiol Community Health 49:87–93PubMedCrossRefGoogle Scholar

Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2007

Authors and Affiliations

  1. 1.Agency for Health Technology AssessmentMinistry of Health and Consumer AffairsMadridSpain
  2. 2.Agency for Health Technology AssessmentInstituto de Salud Carlos IIIMadridSpain

Personalised recommendations