Rheumatology International

, Volume 26, Issue 12, pp 1063–1072

Estimation of direct unit costs associated with non-vertebral osteoporotic fractures in five European countries

  • S. Bouee
  • A. Lafuma
  • F. Fagnani
  • P. J. Meunier
  • J. Y. Reginster


The objective of this study was to estimate the unit costs of non-vertebral osteoporotic fractures in five European countries based on the results of the SOTI and TROPOS clinical trials in postmenopausal osteoporotic women. The information recorded in the Case Report Forms was used. The perspective of third party payers was adopted. Hip fracture unit cost was the highest. The ranges of costs among countries was narrow for hip from 8,346€ (Italy) to 9,907€ (France), but wider for other fractures: 890€ (Spain) to 2,022€ (Italy) for wrist, 1,167€ (Spain) to 3,268€ (Italy) for pelvis, 837€ (Spain) to 2,116€ (Italy) for sternum/clavicle, 565€ (Spain) to 908€ (France) for rib, 1,518€ (Spain) to 3,651€ (Belgium) for humerus, 1,805€ (Spain) to 3,521€ (Italy) for leg. The costs of those fractures should be considered when estimating the cost of osteoporosis.


Osteoporosis Non-vertebral fracture Cost 


  1. 1.
    Consensus development conference (1993) Diagnosis, prophylaxis and treatment of osteoporosis. Am J Med 94:646–650Google Scholar
  2. 2.
    Kanis JA, Melton LJ, Christiansen C, Johnston CC, Khaltaev N (1994) The diagnosis of osteoporosis. J Bone Miner Res 9:1137–1141PubMedGoogle Scholar
  3. 3.
    Johnell O, Kanis J (2005) Epidemiology of osteoporotic fractures. Osteoporos Int 16(Suppl 2):S3–S7PubMedCrossRefGoogle Scholar
  4. 4.
    Kanis JA, Johnell O, Oden A, Sernbo I, Redlund-Johnell I, Dawson A, De Laet C, Jonsson B (2000) Long-term risk of osteoporotic fracture in Malmo. Osteoporos Int 11(8):669–674PubMedCrossRefGoogle Scholar
  5. 5.
    Cooper C, Campion G, Melton LJ III (1992) Hip fractures of the elderly: a worldwide projection. Osteoporos Int Int 2:285–289PubMedCrossRefGoogle Scholar
  6. 6.
    Gillet P, Reginster JY (1999) Increased number of hip fractures. Lancet 353:2160–2161PubMedCrossRefGoogle Scholar
  7. 7.
    Melton LJ III (1999) Cost-effective treatment strategies for osteoporosis. Osteoporosis Int 9(Suppl 2):S111–S116CrossRefGoogle Scholar
  8. 8.
    Holland E, Rogers L (1989) Osteoporosis: impact on the elderly, sociatal concerns, and the role of radiology. Curr Probl Diagn Radiol 18:46–61CrossRefGoogle Scholar
  9. 9.
    Edy DM, Johnston CC Jr, Cummings SR (1998) Osteoporosis: review of the evidence for prevention, diagnosis, and treatment and cost-effectiveness analysis. Status report. Osteoporos Int 8(Suppl 4):1–88Google Scholar
  10. 10.
    US Congress Office of Technology Assessment (1994) Hip fracture outcomes in people age 50 and over: background paper. Washington DC/ US Goverment Printing office, JulyGoogle Scholar
  11. 11.
    Johnell O (1997) The socioeconomic burden of fractures: today and in the 21st century. Am J Med 103(2A):20S–25SPubMedCrossRefGoogle Scholar
  12. 12.
    Gabriel SE, Tosteson AN, Leibson CL, Crowson CS, Pond GR, Hammond CS, Melton LJ 3rd (2002) Direct medical costs attributable to osteoporotic fractures. Osteoporos Int 13(4):323–330PubMedCrossRefGoogle Scholar
  13. 13.
    Meunier PJ, Reginster JY (2003) Design and methodology of the phase 3 trials for the clinical development of strontium ranelate in the treatment of women with postmenopausal osteoporosis. Osteoporos Int 14(Suppl 3):S66–S76PubMedGoogle Scholar
  14. 14.
    Reginster JY, Lecart MP, Deroisy R, Lousberg C (2004) Strontium ranelate: a new paradigm in the treatment of osteoporosis. Expert Opin Investig Drugs 13(7):857–864PubMedCrossRefGoogle Scholar
  15. 15.
    Meunier PJ, Roux C, Seeman E, Ortolani S, Badurski JE, Spector TD, Cannata J, Balogh A, Lemmel EM, Pors-Nielsen S, Rizzoli R, Genant HK, Reginster JY (2004) The effects of strontium ranelate on the risk of vertebral fracture in women with postmenopausal osteoporosis. N Engl J Med 350:459–468PubMedCrossRefGoogle Scholar
  16. 16.
    Reginster JY, Seeman E, De Vernejoul MC, Adami S, Compston J, Phenekos C, Devogelaer JP, Curiel MD, Sawicki A, Goemaere S, Sorensen OH, Felsenberg D, Meunier PJ (2005) Strontium, ranelate reduces the risk of nonvertebral fractures in post-menopausal women with osteoporosis: treatment of peripheral osteoporosis (TROPOS) study. J Clinical Endocrinol Metab 90(5):2816–2822CrossRefGoogle Scholar
  17. 17.
    Data available on the site: http://www.oecd.org/dataoecd/13/12/31963479.xls. Consulted on November 2nd 2005
  18. 18.
    Lindsay R (1995) The burden of osteoporosis: cost. Am J Med 98(2A):9S–11SPubMedCrossRefGoogle Scholar
  19. 19.
    Levy E (1989) Cost analysis of osteoporosis related to untreated menopause. Clin Rheumatol 8(Suppl 2):76–82PubMedCrossRefGoogle Scholar
  20. 20.
    Jönsson B, Christiansen C, Johnell O, Hedbrandt J (1995) Cost-effectiveness of fracture prevention in established osteoporosis. Osteoporos Int 5(2):136–142PubMedCrossRefGoogle Scholar
  21. 21.
    Kakarlapudi TK, Santini A, Shahane SA, Douglas D (2000) The cost of treatment of distal radial fractures. Injury 31(4):229–232PubMedCrossRefGoogle Scholar
  22. 22.
    French FH, Torgerson DJ, Porter RW (1995) Cost analysis of fracture of the neck of femur. Age Ageing 24(3):185–189PubMedCrossRefGoogle Scholar
  23. 23.
    Reginster JY, Gillet P, Ben Sedrine W, Brands G, Ethgen O, De Froimont C, Gosset C (1999) Direct costs of hip fractures in patients over 60 years of age in Belgium. Pharmacoeconomics 15(5):507–514PubMedCrossRefGoogle Scholar
  24. 24.
    Parker MJ, Myles JW, Pryor GA, Lodwick R (1991) Cost analysis of different aspects of treatment of patients following fracture of the proximal femur. J Bone Joint Surg Br 73B:70Google Scholar
  25. 25.
    Visentin P, Ciravegna R, Fabris F (1997) Estimating the cost per avoided hip fracture by osteoporosis treatment in Italy. Maturitas 26(3):185–192PubMedCrossRefGoogle Scholar
  26. 26.
    Hollingworth W, Todd CJ, Parker MJ (1996) The cost of treating hip fractures in the twenty-first century: short report. Osteoporos Int 6(Suppl 2):13–15PubMedCrossRefGoogle Scholar
  27. 27.
    Dolan P, Torgerson DJ (1998) The cost of treating osteoporotic fractures in the United Kingdom female population. Osteoporos Int 8(6):611–617PubMedCrossRefGoogle Scholar
  28. 28.
    Schurch MA, Rizzoli R, Mermillod B, Vasey H, Michel JP, Bonjour JP (1996) A prospective study on socioeconomic aspects of fracture of the proximal femur. J Bone Miner Res 11(12):1935–1942PubMedCrossRefGoogle Scholar
  29. 29.
    Koeck CM, Schwappach DL, Niemann FM, Strassmann TJ, Ebner H, Klaushofer K (2001) Incidence and costs of osteoporosis-associated hip fractures in Austria. Wien Klin Wochenschr 113(10):371–377PubMedGoogle Scholar
  30. 30.
    Ankjaer-Jensen A, Johnell O (1996) Prevention of osteoporosis: cost-effectiveness of different pharmaceutical treatments. Osteoporos Int 6:265–275PubMedCrossRefGoogle Scholar
  31. 31.
    Borgquist L, Lindelöw G, Thorngren KG (1991) Costs of hip fracture. Rehabilitation of 180 patients in primary health care. Acta Orthop Scand 62:39–48PubMedCrossRefGoogle Scholar
  32. 32.
    Koeck CM, Schwappach DL, Niemann FM, Strassmann TJ, Ebner H, Klaushofer K (2001) Incidence and costs of osteoporosis-associated hip fractures in Austria. Wien Klin Wochenschr 113(10):371–377PubMedGoogle Scholar
  33. 33.
    Brecht JG, Kruse HP, Felsenberg D, Mohrke W, Oestreich A, Huppertz E (2003) Pharmacoeconomic analysis of osteoporosis treatment with risedronate. Int J Clin Pharmacol Res 23(4):93–105PubMedGoogle Scholar
  34. 34.
    Haentjens P, Autier P, Barette M, Boonen S; Belgian Hip Fracture Study Group (2001) The economic cost of hip fractures among elderly women. A one-year, prospective, observational cohort study with matched-pair analysis. Belgian Hip Fracture Study Group. J Bone Joint Surg Am 83-A(4):493–500Google Scholar
  35. 35.
    Nurmi I, Narinen A, Luthje P, Tanninen S (2003) Cost analysis of hip fracture treatment among the elderly for the public health services: a 1-year prospective study in 106 consecutive patients. Arch Orthop Trauma Surg 123(10):551–554PubMedCrossRefGoogle Scholar
  36. 36.
    De Laet CE, van Hout BA, Burger H, Weel AE, Hofman A, Pols HA (1999) Incremental cost of medical care after hip fracture and first vertebral fracture: the Rotterdam study. Osteoporos Int 10(1):66–72PubMedCrossRefGoogle Scholar
  37. 37.
    Sernbo I, Johnell O (1993) Consequences of hip fracture: a prospective study over 1 year. Osteoporosis Int 3:148–153CrossRefGoogle Scholar
  38. 38.
    Zethraeus N, Gerdtham UG (1998) Estimating the costs of hip fracture and potential savings. Int J Technol Assess Health Care 14(2):255–267PubMedCrossRefGoogle Scholar
  39. 39.
    Kanis JA, Brazier JE, Stevenson M, Calvert NW, Lloyd Jones M (2002) Treatment of established osteoporosis: a systematic review and cost-utility analysis. Health Technol Assess 6(29):1–146PubMedGoogle Scholar
  40. 40.
    Chamberlin B, Benazet JP, Humbert B, Saillant G (1999) Direct cost assessment of wrist fractures. Rev Chir Orthop Reparatrice Appar Mot 85(8):828–833PubMedGoogle Scholar
  41. 41.
    Seeley DG, Browner WS, Nevitt MC, Genant HK, Scott JC, Cummings SR (1991) Which fractures are associated with low appendicular bone mass in the elderly women? The Study of Osteoporotic Fractures Research Group. Ann Intern Med 115:837–842PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2006

Authors and Affiliations

  • S. Bouee
    • 1
  • A. Lafuma
    • 1
  • F. Fagnani
    • 1
  • P. J. Meunier
    • 2
  • J. Y. Reginster
    • 3
  1. 1.CEMKABourg La ReineFrance
  2. 2.Hôpital Edouard HerriotLyon cedex 03France
  3. 3.Centre Universitaire d’Investigation du Metabolisme Osseux et du Cartilage ArticulaireUniversity of LiegeLiegeBelgium

Personalised recommendations