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Annual out-of-pocket expenditure associated with healthcare use among Australian older women with osteoporosis: a cross-sectional study



This research aimed to determine the health care cost and utilisation of older Australian women with osteoporosis. A wide range of healthcare services were used and approximately AU$593.9 was spent over a 12-month period for these services. This highlights the significant cost burden of osteoporosis on the healthcare system.


Osteoporosis is a common skeletal condition among women that has a considerable impact on quality of life. The purpose of this study is to determine the prevalence of healthcare use and to estimate associated out-of-pocket expenditure for the management of osteoporosis in older Australian women.


Data was obtained from 393 Australian women from the 45 and Up Study who had osteoporosis. The women were asked about healthcare use for their osteoporosis, including conventional medicine, complementary medicine, and self-care practices or self-care products, and associated out-of-pocket expenditure for that use over 12 months.


The average age of participants was 72.0 years. Over a 12-month period, the majority of participants (72%) consulted a doctor for their osteoporosis, 24% consulted an allied health practitioner, and 20% consulted a complementary medicine practitioner. Participants had a mean of 6.8 consultations with healthcare practitioners in the previous 12 months for the osteoporosis. In addition, 46% participants used three or more types of complementary medicine products/practices in the previous 12 months. Overall, the participants incurred a (arithmetic) mean ofAU$594 (median = $350; inter-quartile range = $450) in out-of-pocket expenditure for healthcare use over the 12-month period.


Women with osteoporosis use a wide range of healthcare services that are associated with significant annual out-of-pocket expenditure. Preventive strategies can help decrease the cost burden of osteoporosis on the healthcare system.

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Data availability

The data set and sub-study questionnaire could potentially be made available to other researchers if they obtain the necessary approvals. Further information on this process can be obtained from the 45 and Up Study (45andUp.research@


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This research was completed using data collected through the 45 and Up Study ( The 45 and Up Study is managed by the Sax Institute in collaboration with major partner Cancer Council NSW; and partners: the Heart Foundation; NSW Ministry of Health; NSW Department of Communities and Justice; and the Australian Red Cross Blood Service. We thank the many thousands of people participating in the 45 and Up Study.


The Australian Research Council (DP140100238) funded this sub-study of women with osteoarthritis upon which this research paper is based.

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Authors and Affiliations



DS and JA conceptualised and designed the study; MH analysed the data and performed the statistical analysis. MH and JB drafted the original manuscript. All authors contributed to the manuscript and approved the final version.

Corresponding author

Correspondence to Jessica Bayes.

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Ethics statements

Ethical approval for the use of the sub-study dataset from the 45 and Up Study was gained from the Human Research Ethics Committees at the University of Technology Sydney on 7th October 2015 (UTS HREC REF NO. 2015000683).

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Adams, J., Bayes, J., Hosseini, M. et al. Annual out-of-pocket expenditure associated with healthcare use among Australian older women with osteoporosis: a cross-sectional study. Arch Osteoporos 16, 148 (2021).

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  • Osteoporosis
  • Healthcare
  • Complementary medicine
  • Out-of-pocket expenditure