Skip to main content

Advertisement

SpringerLink
Log in

The mortality and direct medical costs of osteoporotic fractures among postmenopausal women in Taiwan

  • Original Article
  • Published:
Osteoporosis International Aims and scope Submit manuscript

Abstract

Summary

This study estimated the fracture-related mortality and direct medical costs among postmenopausal women in Taiwan by fracture types and age groups by utilizing a nationwide population-based database. Results demonstrated that hip fractures constituted the most severe and expensive complication of osteoporosis across fracture sites.

Introduction

The aims of the study were to evaluate the risk of death and direct medical costs associated with osteoporotic fractures by fracture types and age groups among postmenopausal women in Taiwan.

Methods

This nationwide, population-based study was based on data from the National Health Insurance Research Database in Taiwan. Female patients aged 50 years and older in the fracture case cohort were matched in 1:1 ratio with randomly selected subjects in the reference control cohort by age, income-related insurance amount, urbanization level, and the Charlson comorbidity index. There were two main outcome measures of the study: age-differentiated mortality and direct medical costs in the first and subsequent years after osteoporotic fracture events among postmenopausal women. The bootstrap method by resampling with replacement was conducted to generate descriptive statistics of mortality and direct medical costs of the case and control cohorts. Student’s t tests were then performed to compare mortality and costs between the two cohorts.

Results

A total of 155,466 postmenopausal women in the database met the inclusion criteria for the fracture case cohort, including 22,791 hip fractures, 72,292 vertebral fractures, 15,621 upper end humerus (closed) fractures, 36,774 wrist fractures, and 7,988 multiple fractures. Analytical results demonstrated that patients experiencing osteoporotic fractures were at considerable excess risk of death and incurred substantially higher treatment costs, notably for hip fractures. Furthermore, results also revealed that the risk of mortality increased with advancing age across the spectrum of fracture sites.

Conclusions

The present study confirmed an excess mortality and higher direct medical costs associated with osteoporotic fractures. Moreover, hip fractures constituted the most severe and expensive complication of osteoporosis among fracture types.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Johnell O, Kanis JA (2006) An estimate of the worldwide prevalence and disability associated with osteoporotic fractures. Osteoporos Int 17:1726–1733

    Article  CAS  PubMed  Google Scholar 

  2. Dennison E, Mohamed MA, Cooper C (2006) Epidemiology of osteoporosis. Rheum Dis Clin N Am 32:617–629

    Article  Google Scholar 

  3. Ettinger B, Black DM, Nevitt MC, Rundle AC, Cauley JA, Cummings SR, Genant HK (1992) Contribution of vertebral deformities to chronic back pain and disability. The study of osteoporotic fractures research group. J Bone Miner Res 7:449–456

    Article  CAS  PubMed  Google Scholar 

  4. Ross PD, Ettinger B, Davis JW, Melton LJ 3rd, Wasnich RD (1991) Evaluation of adverse health outcomes associated with vertebral fractures. Osteoporos Int 1:134–140

    Article  CAS  PubMed  Google Scholar 

  5. Center JR, Nguyen TV, Schneider D, Sambrook PN, Eisman JA (1999) Mortality after all major types of osteoporotic fracture in men and women: an observational study. Lancet 353:878–882

    Article  CAS  PubMed  Google Scholar 

  6. Cauley JA, Thompson DE, Ensrud KC, Scott JC, Black D (2000) Risk of mortality following clinical fractures. Osteoporos Int 11:556–561

    Article  CAS  PubMed  Google Scholar 

  7. Todd C, Freeman C, Camilleri-Ferrante C, Palmer CR, Hyder A, Laxton CE, Parker M, Payne BV, Rushton N (1995) Differences in mortality after fracture of the hip. BMJ 310:904–908

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  8. Forsen L, Sogaard AJ, Meyer HE, Edna T-H, Kopjar B (1999) Survival after hip fracture: short- and long-term excess mortality according to age and gender. Osteoporos Int 10:73–78

    Article  CAS  PubMed  Google Scholar 

  9. Johnell O, Kanis JA, Oden A, Sernbo I, Redlund-Johnell I, Petterson C, De Laet C, Jonsson B (2004) Mortality after osteoporotic fractures. Osteoporos Int 15:38–42

    Article  CAS  PubMed  Google Scholar 

  10. Frost SA, Nguyen ND, Center JR, Eisman JA, Nguyen TV (2013) Excess mortality attributable to hip-fracture: a relative survival analysis. Bone 56:23–29

    Article  PubMed  Google Scholar 

  11. Bliuc D, Nguyen ND, Milch VE, Nguyen TV, Eisman JA, Center JR (2009) Mortality risk associated with low-trauma osteoporotic fracture and subsequent fracture in men and women. JAMA 301:513–521

    Article  CAS  PubMed  Google Scholar 

  12. Ioannidis G, Flahive J, Pickard L, Papaioannou A, Chapurlat RD, Saag KG, Silverman S, Anderson FA Jr, Gehlbach SH, Hooven FH, Boonen S, Compston JE, Cooper C, Diez-Perez A, Greenspan SL, Lacroix AZ, Lindsay R, Netelenbos JC, Pfeilschifter J, Rossini M, Roux C, Sambrook PN, Siris ES, Watts NB, Adachi JD, GLOW Investigators (2013) Non-hip, non-spine fractures drive healthcare utilization following a fracture: the Global Longitudinal Study of Osteoporosis in Women (GLOW). Osteoporos Int 24:59–67

    Article  CAS  PubMed  Google Scholar 

  13. Blume SW, Curtis JR (2011) Medical costs of osteoporosis in the elderly Medicare population. Osteoporos Int 22:1835–1844

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  14. Shi N, Foley K, Lenhart G, Badamgarav E (2009) Direct healthcare costs of hip, vertebral, and non-hip, non-vertebral fractures. Bone 45:1084–1090

    Article  PubMed  Google Scholar 

  15. Viswanathan HN, Curtis JR, Yu J, White J, Stolshek BS, Merinar C, Balasubramanian A, Kallich JD, Adams JL, Wade SW (2012) Direct healthcare costs of osteoporosis-related fractures in managed care patients receiving pharmacological osteoporosis therapy. Appl Health Econ Health Policy 10:163–173

    Article  PubMed  Google Scholar 

  16. Burge R, Dawson-Hughes B, Solomon DH, Wong JB, King A, Tosteson A (2007) Incidence and economic burden of osteoporosis-related fractures in the United States, 2005–2025. J Bone Miner Res 22:465–475

    Article  PubMed  Google Scholar 

  17. Katelaris AG, Cumming RG (1996) Health status before and mortality after hip fracture. Am J Public Health 86:557–560

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  18. Kanis JA, Oden A, Johnell O, De Laet C, Jonsson B (2004) Excess mortality after hospitalization for vertebral fracture. Osteoporos Int 15:108–112

    Article  PubMed  Google Scholar 

  19. Drummond MF, Sculpher MJ, Torrance GW, O’Brien BJ, Stoddart GL (2005) Methods for the economic evaluation of health care programs, 3rd edn. Oxford University Press, New York

    Google Scholar 

  20. (2008) NAHSIT 2004–2008: Nutrition and Health Survey in Taiwan. https://srda.sinica.edu.tw/search/scidown/4749. Accessed 30 September 2014

  21. Bessette L, Jean S, Lapointe-Garant MP, Belzile EL, Davison KS, Ste-Marie LG, Brown JP (2012) Direct medical costs attributable to peripheral fractures in Canadian post-menopausal women. Osteoporos Int 23:1757–1768

    Article  CAS  PubMed  Google Scholar 

  22. (2014) National Health Insurance Research Database, Taiwan. http://www.nhri.org.tw/nhird/en/index.htm. Accessed 10 October 2014

  23. Chen YC, Yeh HC, Wu JC, Haschler I, Chen TJ, Wetter T (2011) Taiwan’s National Health Insurance Research Database: administrative health care database as study object in bibliometrics. Scientometrics 86:365–380

    Article  Google Scholar 

  24. Cheng CL, Kao YH, Lin SJ, Lee CH, Lai ML (2011) Validation of the National Health Insurance Research Database with ischemic stroke cases in Taiwan. Pharmacoepidemiol Drug Saf 20:236–242

    Article  PubMed  Google Scholar 

  25. Lin CC, Lai MS, Syu CY, Chang SC, Tseng FY (2005) Accuracy of diabetes diagnosis in health insurance claims data in Taiwan. J Formos Med Assoc 104:157–163

    PubMed  Google Scholar 

  26. Deyo RA, Cherkin DC, Ciol MA (1992) Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases. J Clin Epidemiol 45:613–619

    Article  CAS  PubMed  Google Scholar 

  27. Efron B, Tibshirani R (1993) An introduction to the bootstrap (Chapman & Hall/CRC Monographs on Statistics & Applied Probability). Chapman & Hall/CRC, Boca Raton, FL

    Book  Google Scholar 

  28. Barber JA, Thompson SG (2000) Analysis of cost data in randomized trials: an application of the non-parametric bootstrap. Stat Med 19:3219–3236

    Article  CAS  PubMed  Google Scholar 

  29. Grønskag AB, Romundstad P, Forsmo S, Langhammer A, Schei B (2012) Excess mortality after hip fracture among elderly women in Norway. The HUNT study. Osteoporos Int 23:1807–1811

    Article  PubMed  Google Scholar 

  30. Ioannidid G, Papaioannou A, Hopman WM, Akhtar-Danesh N, Anastassiades T, Pickard L, Kennedy CC, Prior JC, Olszynski WP, Davison KS, Goltzman D, Thabane L, Gafni A, Papadimitropoulos EA, Brown JP, Josse RG, Hanley DA, Adachi JD (2009) Relation between fractures and mortality: results from the Canadian Multicentre Osteoporosis Study. CMAJ 181:265–271

    Article  Google Scholar 

  31. Omsland TK, Emaus N, Tell GS, Magnus JH, Ahmed LA, Holvik K, Center J, Forsmo S, Gjesdal CG, Schei B, Vestergaard P, Eisman JA, Falch JA, Tverdal A, Søgaard AJ, Meyer HE (2014) Mortality following the first hip fracture in Norwegian women and men (1999–2008). A NOREPOS study. Bone 63:81–86

    Article  PubMed  Google Scholar 

  32. Roche JJ, Wenn RT, Sahoat O, Moran CG (2005) Effect of comorbidities and postoperative complications on mortality after hip fracture in elderly people: prospective observational cohort study. BMJ 331:1374–1376

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  33. Kim SM, Moon YW, Lim SJ, Yoon BK, Min YK, Lee DY, Park YS (2012) Prediction of survival, second fracture, and functional recovery following the first hip fracture surgery in elderly patients. Bone 50:1343–1350

    Article  PubMed  Google Scholar 

  34. Maggi S, Siviero P, Wetle T, Besdine RW, Saugo M, Crepaldi G (2010) A multicenter survey on profile of care for hip fracture: predictors of mortality and disability. Osteoporos Int 21:223–231

    Article  CAS  PubMed  Google Scholar 

  35. 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 10:66–72

    Article  PubMed  Google Scholar 

  36. Ray WA, Griffin MR, Fought RL, Adams ML (1992) Identification of fractures from computerized Medicare files. J Clin Epidemiol 45:703–714

    Article  CAS  PubMed  Google Scholar 

  37. Jean S, Candas B, Belzile E, Morin S, Bessette L, Dodin S, Brown JP (2012) Algorithms can be used to identify fragility fracture cases in physician-claims databases. Osteoporos Int 23:483–501

    Article  CAS  PubMed  Google Scholar 

  38. Curtis JR, Mudano AS, Solomon DH, Xi J, Melton ME, Saag KG (2009) Identification and validation of vertebral compression fractures using administrative claims data. Med Care 47:69–72

    Article  PubMed Central  PubMed  Google Scholar 

  39. Hudson M, Avina-Zubieta A, Lacaille D, Bernatsky S, Lix L, Jean S (2013) The validity of administrative data to identify hip fractures is high—a systematic review. J Clin Epidemiol 66:278–285

    Article  PubMed  Google Scholar 

  40. Pluijm SM, Smit JH, Tromp EA, Stel VS, Deeg DJ, Bouter LM, Lips P (2006) A risk profile for identifying community-dwelling elderly with a high risk of recurrent falling: results of a 3-year prospective study. Osteoporos Int 17:417–425

    Article  CAS  PubMed  Google Scholar 

  41. Singer A, Exuzides A, Spangler L, O’Malley C, Colby C, Johnston K, Agodoa I, Baker J, Kagan R (2015) Burden of illness for osteoporotic fractures compared with other serious diseases among postmenopausal women in the United States. Mayo Clin Proc 90:53–62

    Article  PubMed  Google Scholar 

  42. Leboime A, Confavreux CB, Mehsen N, Paccou J, David C, Roux C (2010) Osteoporosis and mortality. Joint Bone Spine 77(Suppl 2):S107–S112

    Article  PubMed  Google Scholar 

  43. Kenzora JE, McCarthy RE, Lowell JD, Sledge CB (1984) Hip fracture mortality: relation to age, treatment, preoperative illness, time of surgery, and complications. Clin Orthop Relat Res 186:45–56

    PubMed  Google Scholar 

Download references

Acknowledgments

This study is based in part on data obtained from the National Health Insurance Research Database provided by the National Health Insurance Administration of Ministry of Health and Welfare, and managed by the National Health Research Institutes, Taiwan. The interpretation and conclusions contained herein do not represent those of the National Health Insurance Administration, the Ministry of Health and Welfare, or the National Health Research Institutes, Taiwan. This study is partially funded by Ministry of Science and Technology (then National Science Council), the Executive Yuan, Taiwan (to C.-H. Tang), under the grant number (96-2416-H-038-001-MY3).

Conflicts of interest

None.

Author information

Author notes

    Authors and Affiliations

    1. Division of Orthopedic Surgery, Hsinchu Cathay General Hospital, Hsinchu, Taiwan

      C.-Y. Chang

    2. School of Health Care Administration, Taipei Medical University, No. 250, Wu-Hsing Street, Taipei, Taiwan

      C.-H. Tang, K.-C. Chen, K.-C. Huang & K.-C. Huang

    Authors
    1. C.-Y. Chang
      View author publications

      You can also search for this author in PubMed Google Scholar

    2. C.-H. Tang
      View author publications

      You can also search for this author in PubMed Google Scholar

    3. K.-C. Chen
      View author publications

      You can also search for this author in PubMed Google Scholar

    4. K.-C. Huang
      View author publications

      You can also search for this author in PubMed Google Scholar

    5. K.-C. Huang
      View author publications

      You can also search for this author in PubMed Google Scholar

    Corresponding author

    Correspondence to K.-C. Huang.

    Additional information

    C.-Y. Chang and C.-H. Tang contributed equally to this work.

    Rights and permissions

    Reprints and permissions

    About this article

    Check for updates. Verify currency and authenticity via CrossMark

    Cite this article

    Chang, CY., Tang, CH., Chen, KC. et al. The mortality and direct medical costs of osteoporotic fractures among postmenopausal women in Taiwan. Osteoporos Int 27, 665–676 (2016). https://doi.org/10.1007/s00198-015-3238-3

    Download citation

    • Received:

    • Accepted:

    • Published:

    • Issue Date:

    • DOI: https://doi.org/10.1007/s00198-015-3238-3

    Keywords

    Search

    Navigation