, Volume 15, Issue 5, pp 507–514 | Cite as

Direct Costs of Hip Fractures in Patients Over 60 Years of Age in Belgium

  • Jean-Yves Reginster
  • Pierre Gillet
  • Wafa Ben Sedrine
  • Geoffrey Brands
  • Olivier Ethgen
  • Cécile de Froidmont
  • Christiane Gosset
Original Research Article Costs of Hip Fractures in Belgium


Objective: Osteoporosis-related costs are now considered a major burden for health authorities in most developed countries. An accurate and exhaustive evaluation of these costs would be a major contribution to health economic studies evaluating the efficiency of screening and prevention strategies. Osteoporosis is the most frequent underlying cause of femoral neck fractures in the elderly; these fractures weigh heavily on healthcare budgets. However, in Belgium, very few data on the financial burden of hip fractures are available and no updated estimates have been made. The goal of this paper is to estimate the direct medical expenditures associated with hip fractures in Belgium in 1996.

Design and setting: This 1-year population-based cross-sectional study is conducted from the social security perspective. The target population in this study are men and women aged 60 years and over.

Patients and participants: We selected patients who had been hospitalised for a hip fracture during the year 1996 who were also affiliated with a registered social security organisation (covering 25% of the Belgian population). The sample constituted 2374 patients.

Interventions: For each of these patients, we collected an exhaustive and detailed list of healthcare resource use as well as nursing home admissions following the hip fracture event. Cost items investigated in the analysis were inpatient hospital costs and outpatient costs. Mean annual costs per case recorded in the sample were then extrapolated to the whole country on the basis of an exhaustive list of diagnoses having lead to all countrywide hospitalisations (1700000 hospital stays/year).

Main outcome measures and results: The mean hospital inpatient costs for hip fracture were evaluated at 332 148 Belgian francs (BeF) [$US8977] per case and BeF4 367 746 200 ($US118 047 194) for the whole country (10 million inhabitants). Patients with a hip fracture experienced an annual BeF27 825 ($US752) extra outpatient cost during the year following this fracture event, after correcting for costs related to additional comorbidity already present before the hip fracture. Finally, after a proximal femoral neck fracture, the rate of nursing home admission was higher, both for men and women at any age compared with age- and gendermatched population.

Conclusions: With a total cost (acute hospital and outpatient costs) of BeF4 667 894 950 ($US126 159 323) per year in Belgium, proximal femoral neck fracture should be considered a major health economic problem and appropriate measures to prevent this disease should be rapidly undertaken.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Keene GS, Parker MJ, Pryor GA. Mortality and morbidity after hip fractures. BMJ 1993; 307: 1219–50CrossRefGoogle Scholar
  2. 2.
    Chrischilles E, Shireman T, Wallace R. Costs and health effects of osteoporotic fractures. Bone 1994; 15: 377–86PubMedCrossRefGoogle Scholar
  3. 3.
    Phillips S, Fox N, Jacobs J, et al. The direct medical costs of osteoporosis for American women aged 45 and older. Bone 1988; 9: 271–9PubMedCrossRefGoogle Scholar
  4. 4.
    Melton LJ. Hip fractures: a worldwide problem today and tomorrow. Bone 1993; 14: S1–8CrossRefGoogle Scholar
  5. 5.
    Gillet P, Gosset C, Reginster JY. Direct social costs of osteoporotic hip fractures in Belgium [abstract]. Calcif Tissue Int 1997; 61: 499Google Scholar
  6. 6.
    Nagant de Deuxchaisnes C, Devogelaer JP. Increase in the incidence of hip fractures and of the ratio of trochanteric to cervical hip fractures in Belgium. Calcif Tissue Int 1988; 42: 201–3CrossRefGoogle Scholar
  7. 7.
    Gillet P, Gosset C, Reginster JY. Osteoporosis: the interest of a prospective vision [abstract]. Calcif Tissue Int 1997; 61: 499Google Scholar
  8. 8.
    Emeriau JP, Maurette P, Tiret L, et al. Morbidité et cout des fractures du col. Encyclopédie Médo Chir 1991; 98: 31–6Google Scholar
  9. 9.
    Prier A. Incidence et conséquences socio-économiques des fractures du col du fémur. Sem Hop 1990; 66: 2144–6Google Scholar
  10. 10.
    Baudoin C. The cost of osteoporosis in France. Rev Rhum Engl Ed 1997; 64: 441–2PubMedGoogle Scholar
  11. 11.
    Baudoin C, Fardellone P, Bean K, et al. Clinical outcomes and mortality after hip fractures: a 2-year follow-up study. Bone 1996; 18: 149–57CrossRefGoogle Scholar
  12. 12.
    Levy E. Cost analysis of osteoporosis related to untreated menopause. Clin Rheum 1989; 8 Suppl. 2: S76–82CrossRefGoogle Scholar
  13. 13.
    Lyritis G. Epidemiology and socioeconomic cost of osteoporotic fractures in Greece. Calcif Tissue Int 1992; 51: 93–4PubMedCrossRefGoogle Scholar
  14. 14.
    Lopez Vaz A. Epidemiology and costs of osteoporotic hip fractures in Portugal. Bone 1993; 14 Suppl. 3: S9–10Google Scholar
  15. 15.
    Sernbo I, Johnell O. Consequences of a hip fracture: a prospective study over 1 year. Osteoporos Int 1993; 3: 148–53PubMedCrossRefGoogle Scholar
  16. 16.
    Schürch MA, Rizzoli R, Mermillod B, et al. A prospective study on socioeconomic aspects of fracture of the proximal femur. J Bone Miner Res 1996; 11: 1935–42PubMedCrossRefGoogle Scholar
  17. 17.
    Lippuner K, von Overbeck J, Perrelet R, et al. Incidence and direct medical costs of hospitalizations due to osteoporotic fractures in Switzerland. Osteoporos Int 1997; 7: 414–25PubMedCrossRefGoogle Scholar
  18. 18.
    Kramer AM, Steiner JF, Schlenker RE, et al. Outcomes and costs after hip fracture and stroke: a comparison of rehabilitation settings. JAMA 1997; 277: 396–404PubMedCrossRefGoogle Scholar
  19. 19.
    Randell A, Sambrook PN, Nguyen TV. Direct clinical and welfare costs of osteoporotic fractures in elderly men and women. Osteoporos Int 1995; 5: 427–32PubMedCrossRefGoogle Scholar
  20. 20.
    Lane A. Direct costs of osteoporosis for New Zealand women. Pharmacoeconomics 1996; 9: 231–45PubMedCrossRefGoogle Scholar
  21. 21.
    Reginster JY. Cost effectiveness of treatments in osteoporosis. J Rheumatol 1996; 23: 1312–3PubMedGoogle Scholar
  22. 22.
    Dere W, Avouac B, Boers M, et al. Recommendations for the health economics analysis to be performed with a drug to be registered in prevention or treatment of osteoporosis. Calcif Tissue Int 1998; 63: 93–7PubMedCrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG 1999

Authors and Affiliations

  • Jean-Yves Reginster
    • 1
    • 2
    • 3
    • 4
  • Pierre Gillet
    • 5
    • 6
  • Wafa Ben Sedrine
    • 1
    • 2
  • Geoffrey Brands
    • 1
    • 2
  • Olivier Ethgen
    • 1
    • 2
  • Cécile de Froidmont
    • 1
    • 2
  • Christiane Gosset
    • 1
    • 2
  1. 1.WHO Collaborating Center for Public Health Aspects of Osteoarticular DisordersLiegeBelgium
  2. 2.Department of Public Health and EpidemiologyUniversity of LiègeLiègeBelgium
  3. 3.Bone and Cartilage Unit, CHU Centre VilleUniversity of LiègeLiègeBelgium
  4. 4.Department of NeurologyGeorgetown University Medical CenterWashingtonUSA
  5. 5.Public Health School, University of LiègeLiègeBelgium
  6. 6.Medical Direction, University Hospital, University of LiègeLiègeBelgium

Personalised recommendations