Osteoporosis International

, Volume 25, Issue 1, pp 195–204 | Cite as

Indirect costs account for half of the total costs of an osteoporotic fracture: a prospective evaluation

  • D. A. EekmanEmail author
  • M. M. ter Wee
  • V. M. H. Coupé
  • S. Erisek-Demirtas
  • M. H. Kramer
  • W. F. Lems
Original Article



Data on direct and indirect costs of clinical fractures in 116 osteoporotic patients 50 years and older were prospectively collected using cost diaries. Indirect costs accounted for roughly half of the total costs, with a contribution of at least 81 % of these costs in employed patients.


The aim of this prospective study was to gain insight into the current total costs of clinical fractures in osteoporotic patients aged 50 years and older.


In a study in the Netherlands, patients prospectively filled out cost diaries every 3 months, during 1 year after a clinical fracture. Primary analyses were performed on those patients with all four cost diaries returned. In-depth analyses of indirect costs were performed, dividing results for employed and unemployed patients. Sensitivity analyses using imputation techniques were performed on patients who returned two or three diaries


Of the 116 included patients, 69 completed all four diaries, 24 only two or three, and 23 patient completed one or no diaries. For all fractures, approximately 50 % of the total costs were due to indirect costs; employed patients contributed for at least 81 % of the indirect cost. Humerus fractures were most expensive with a total 1-year cost of €16.841 per patient. Indirect costs in the group with clinical spine fractures were highest (€12.522), accounting for 89.1 % of the total costs for this fracture.


Indirect costs account for roughly half of the total costs of clinical fractures, which are largely related to sick leave. When performing cost analyses in fracture patients, we advise a societal perspective in which indirect costs are also considered, and to apply a patient derived prospective data collection method to get a ‘true’ and complete image of the total costs due to clinical fractures.


Clinical and osteoporotic fractures Cost diary Fracture liaison service Indirect costs 


Conflicts of interest



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Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2013

Authors and Affiliations

  • D. A. Eekman
    • 1
    • 4
    Email author
  • M. M. ter Wee
    • 1
  • V. M. H. Coupé
    • 2
  • S. Erisek-Demirtas
    • 1
  • M. H. Kramer
    • 3
  • W. F. Lems
    • 1
  1. 1.Department of RheumatologyVU Medical CenterAmsterdamThe Netherlands
  2. 2.Department of Epidemiology &BiostatisticsVU Medical CenterAmsterdamThe Netherlands
  3. 3.Department of Internal MedicineVU Medical CenterAmsterdamThe Netherlands
  4. 4.Department of rheumatology ZH3A-52VU University HospitalAmsterdamThe Netherlands

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