Osteoporosis International

, Volume 12, Issue 5, pp 417–427

The Burden of Osteoporotic Fractures: A Method for Setting Intervention Thresholds

  • J. A. Kanis
  • A. Oden
  • O. Johnell
  • B. Jonsson
  • C. de Laet
  • A. Dawson
Original Article

DOI: 10.1007/s001980170112

Cite this article as:
Kanis, J., Oden, A., Johnell, O. et al. Osteoporos Int (2001) 12: 417. doi:10.1007/s001980170112

Abstract:

The aim of this study was to assess the relationship between morbidity from hip fracture and that from other osteoporotic fractures by age and sex based on the population of Sweden. Osteoporotic fractures were designated as those associated with low bone mineral density (BMD) and those that increased in incidence with age after the age of 50 years. Severity of fractures was weighted according to their morbidity using utility values based on those derived by the National Osteoporosis Foundation. Morbidity from fractures other than hip fracture was converted to hip fracture equivalents according to their disutility weights. Excess morbidity was 3.34 and 4.75 in men and women at the age of 50 years, i.e. the morbidity associated with osteoporotic fractures was 3–5 times that accounted for by hip fracture. Excess moribidity decreased with age to approximately 1.25 between the ages of 85 and 89 years. On the assumption that the age- and sex-specific pattern of fractures due to osteoporosis is similar in different communities, the computation of excess morbidity can be utilized to determine the total morbidity from osteoporotic fractures from knowledge of hip fracture rates alone. Such data can be used to weight probabilities of hip fracture in different countries in order to take into account the morbidity from fractures other than hip fracture, and to modify intervention thresholds based on hip fracture risk alone. If, for example, a 10-year probability of hip fracture of 10% was considered an intervention threshold, this would be exceeded in women with osteoporosis aged 65 years and more, but when weighted for other osteoporotic fractures would be exceeded in all women (and men) with osteoporosis.

Key words:Absolute risk – Hip fracture equivalents – Intervention thresholds – Quality of life – Osteoporotic fracture 

Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2001

Authors and Affiliations

  • J. A. Kanis
    • 1
  • A. Oden
    • 2
  • O. Johnell
    • 3
  • B. Jonsson
    • 4
  • C. de Laet
    • 5
  • A. Dawson
    • 6
  1. 1.WHO Collaborating Centre for Metabolic Bone Diseases, University of Sheffield Medical School, Sheffield, UKGB
  2. 2.Consulting statistician, Gothenberg, SwedenSE
  3. 3.Department of Orthopedics, Malmo General Hospital, Malmo, SwedenSE
  4. 4.Department of Economics, Stockholm School of Economics, Stockholm, SwedenSE
  5. 5.Institute for Medical Technology Assessment, The NetherlandsNL
  6. 6.Lilly Research Centre Ltd, Windlesham, UKGB

Personalised recommendations