Osteoporosis International

, Volume 22, Issue 1, pp 47–56 | Cite as

Economic burden of privately insured non-vertebral fracture patients with osteoporosis over a 2-year period in the US

  • C. Pike
  • H. G. Birnbaum
  • M. Schiller
  • E. Swallow
  • R. T. Burge
  • E. T. Edgell
Original Article



This study assesses the costs of non-vertebral osteoporosis-related fractures patients compared with osteoporosis patients without fractures, focusing on the second year following a fracture. Since fracture patients remained more costly in the second year, their economic burden extends beyond the year in which the fracture occurs.


The purpose of this study is to examine the comorbidity profile, resource use, and direct costs of patients who incur osteoporosis-related non-vertebral (NV) fractures in the United States during the 2 years following an incident fracture, focusing on the second year following a fracture.


Osteoporosis patients (ICD-9-CM: 733.0) with a NV fracture (hip, femur, pelvis, lower leg, upper arm, forearm, rib, and multiple sites) were selected from a privately insured health insurance claims database (>8 million lives, ages 18–64, 1999–2006). These NV fracture patients were randomly matched 1:1 on age, gender, employment status, and geographic region to controls with osteoporosis but without a fracture history. Year-by-year and month-by-month rates of comorbidities, resource use, and direct costs were calculated for the matched sample (N = 3,781).


Comorbidity rates and resource use remained significantly higher among NV fracture patients during second year following an NV fracture compared with controls, although absolute rates of comorbidities and service utilization declined. Mean direct excess costs for NV fracture patients fell from $5,267 in the first year to $2,072 in the second year after a fracture, but remained statistically significant (p < 0.01). Patients with fractures of the pelvis, hip, and femur had the highest excess costs in the second year ($5,121, $3,930, and $3,828, respectively). Although hip fractures had highest excess costs over both years, non-vertebral, non-hip fracture patients made up a larger proportion of the sample and were significantly more costly than controls.


Patients with osteoporosis-related NV fractures have substantial excess costs beyond the first year in which the fracture occurs.


Burden of illness Economics Fracture Non-vertebral Osteoporosis Two-year outcomes 



We thank Dr Susan Dennett of Eli Lilly and Company for her contributions to the study design. We also thank Dr Anna Gu and Hari Sharma for providing computer programming input on various aspects of the analysis.

Conflict of interest

This research project was funded by Eli Lilly and Company. Drs. Russel Burge and Eric Edgell are employees of Eli Lilly and Company in the Global Health Outcomes department. Eli Lilly and Company markets pharmacological therapies for the prevention and treatment of osteoporosis.

Supplementary material

198_2010_1267_MOESM1_ESM.pdf (23 kb)
ESM 1 (PDF 23 kb)


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Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2010

Authors and Affiliations

  • C. Pike
    • 1
  • H. G. Birnbaum
    • 1
  • M. Schiller
    • 1
  • E. Swallow
    • 1
  • R. T. Burge
    • 2
    • 3
  • E. T. Edgell
    • 2
  1. 1.Analysis Group, Inc.BostonUSA
  2. 2.Eli Lilly and CompanyLilly Corporate CenterIndianapolisUSA
  3. 3.University of CincinnatiCincinnatiUSA

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