Osteoporosis International

, Volume 27, Issue 8, pp 2555–2566 | Cite as

Quality of life, resource use, and costs related to hip fracture in Estonia

  • M. JürissonEmail author
  • H. Pisarev
  • J. Kanis
  • F. Borgström
  • A. Svedbom
  • R. Kallikorm
  • M. Lember
  • A. Uusküla
Original Article



We assessed the impact of hip fracture on health-related quality of life (HRQoL) and costs in Estonia. The mean 18-month HRQoL loss in quality adjusted life years (QALY) was estimated at 0.31, and the average cumulative cost from a societal perspective was 8146 euros per hip fracture patient.


The aim of this study is to estimate the impact of hip fracture on HRQoL, resource consumption, and cost over 18 months after the fracture among individuals aged over 50 in Estonia.


A cohort of 205 hip fracture patients ≥50 years was followed up for 18 months. HRQoL was estimated before fracture (recall), after fracture, and at 4, 12, and 18 months using the EQ-5D instrument. Health care utilization and costs were obtained from a public health insurance fund database; social, informal, and indirect costs were estimated using patient-reported data.


Hip fracture resulted in the mean 18-month HRQoL loss of 0.31 QALYs. The mean 18-months cumulative cost of hip fracture from a societal perspective was estimated at 8146 (95 % CI 6236–10717) euros per patient. Most of the cost was related to health care (56 %) and informal care (33 %), while social care contributed only 5 %. Utilization of outpatient rehabilitation and nursing care was low (8 % of patients).


The impact of hip fracture on HRQoL and cost was substantial. Despite appropriate inpatient care, utilization of rehabilitation, nursing care, and social care were low and potentially insufficient to meet the needs of patients with low HRQoL. The shortfall may partially explain a remarkably high use of informal care.


Cost of illness Disease burden Estonia Health-related quality of life Hip fracture Osteoporosis Resource use 



ICUROS is a prospective observational study that follows patients for 18 months after a fracture, collecting data on HRQoL, resource utilization, and costs. The study is run under the auspices of the International Osteoporosis Foundation and has enrolled approximately 6000 patients in 11 countries worldwide, including Estonia, since 2007 [7].

The study was supported by the Estonian Science Foundation grant 9368, the Estonian Ministry of Education and Research grant SF0180060s09, the institutional research grants TARTH15017I (Health research in a continuum of the evidence based health practice in Estonia) and IUT 2-8.

Compliance with ethical standards

Informed consent was obtained from all participants, and the study was approved by the Research Ethics Committee of Tartu University.

Conflicts of interest


Supplementary material

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ESM 1 (XLSX 33 kb)
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ESM 2 (XLSX 46 kb)


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Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2016

Authors and Affiliations

  • M. Jürisson
    • 1
    Email author
  • H. Pisarev
    • 1
  • J. Kanis
    • 2
  • F. Borgström
    • 3
  • A. Svedbom
    • 4
    • 5
  • R. Kallikorm
    • 6
  • M. Lember
    • 6
  • A. Uusküla
    • 1
  1. 1.Department of Public HealthUniversity of TartuTartuEstonia
  2. 2.Centre for Metabolic Bone DiseasesUniversity of Sheffield Medical SchoolSheffieldUK
  3. 3.Medical Management CentreKarolinska InstitutetStockholmSweden
  4. 4.MapigroupStockholmSweden
  5. 5.Unit of Dermatology and Venereology, Department of Medicine, Karolinska InstitutetKarolinska UniversitetssjukhusetStockholmSweden
  6. 6.Department of Internal MedicineUniversity of Tartu and Tartu University HospitalTartuEstonia

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