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The Societal Burden of Osteoporosis

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Abstract

Osteoporosis currently affects 10 million Americans and is responsible for more than 1.5 million fractures annually. The financial burden of osteoporosis is substantial, with annual direct medical costs estimated at 17 to 20 billion dollars. Most of these costs are related to the acute and rehabilitative care following osteoporotic fractures, particularly hip fractures. The societal burden of osteoporosis includes these direct medical costs and the monetary (eg, caregiver time) and nonmonetary costs of poor health. The aging of the US population is expected to increase the prevalence of osteoporosis and the number of osteoporotic fractures. Growth of the older adult population will pose significant challenges to Medicare and Medicaid, which bear most of the cost of osteoporosis. Efforts to address the looming financial burden must focus on reducing the prevalence of osteoporosis and the incidence of costly fragility fractures.

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References

Papers of particular interest, published recently, have been highlighted as:•Of importance ••Of major importance

  1. Sambrook P, Cooper C: Osteoporosis. Lancet 2006, 367:2010–2018. (Published erratum appears in Lancet 2006, 368:28).

    CAS  Google Scholar 

  2. •• Burge R, Dawson-Hughes B, Solomon DH, et al.: Incidence and economic burden of osteoporosis-related fractures in the United States, 2005–2025. J Bone Miner Res 2007, 22:465–475. The authors use Markov state-transition modeling to forecast incidence and cost of osteoporotic fractures over the next 20 years. Inclusion of fracture sites not “strongly associated” with osteoporosis is appropriate recognition of the ambiguity in the definition of “related fractures.”

    Article  PubMed  Google Scholar 

  3. Kaiser Family Foundation: Medicare Chartbook, edn 3. Menlo Park, CA: Henry J. Kaiser Family Foundation; 2005. Also available at http://www.kff.org/medicare/upload/Medicare-Chart-Book-3rd-Edition-Summer-2005-Report.pdf.

  4. Thorpe KE, Howard DH: The rise in spending among Medicare beneficiaries: the role of chronic disease prevalence and changes in treatment intensity. Health Aff (Millwood) 2006, 25:w378–w388.

    Article  Google Scholar 

  5. • Thorpe KE, Ogden LL, Galactionova K: Chronic conditions account for rise in Medicare spending from 1987 to 2006. Health Aff (Millwood) 2010 Feb 18 (Epub ahead of print). This article documents changes in Medicare spending growth during the past 20 years. It highlights the declining role of heart conditions and increased importance of chronic disease management in expenditure growth.

  6. Ben Sedrine W, Radican L, Reginster JY: On conducting burden-of-osteoporosis studies: a review of the core concepts and practical issues. A study carried out under the auspices of a WHO Collaborating Center. Rheumatology (Oxford) 2001, 40:7–14.

    Article  CAS  Google Scholar 

  7. Chrischilles EA, Butler CD, Davis CS, Wallace RB: A model of lifetime osteoporosis impact. Arch Intern Med 1991, 151:2026–2032. (Published erratum appears in Arch Intern Med 1992, 152:655.)

    Article  CAS  PubMed  Google Scholar 

  8. Braithwaite RS, Col NF, Wong JB: Estimating hip fracture morbidity, mortality and costs. J Am Geriatr Soc 2003, 51:364–370.

    Article  PubMed  Google Scholar 

  9. Dolan MM, Hawkes WG, Zimmerman SI, et al.: Delirium on hospital admission in aged hip fracture patients: prediction of mortality and 2-year functional outcomes. J Gerontol A Biol Sci Med Sci 2000, 55:M527–M534.

    CAS  PubMed  Google Scholar 

  10. Lenze EJ, Munin MC, Skidmore ER, et al.: Onset of depression in elderly persons after hip fracture: implications for prevention and early intervention of late-life depression. J Am Geriatr Soc 2007, 55:81–86.

    Article  PubMed  Google Scholar 

  11. Biluc D, Nguyen ND, Milch VE, et al. Mortality risk associated with low-trauma osteoporotic fracture and subsequent fracture in men and women. JAMA 2009, 301:513–521.

    Article  Google Scholar 

  12. Center JR, Nguyen TV, Schneider D, et al.: Mortality after all major types of osteoporotic fracture in men and women: an observational study. Lancet 1999, 353:878–882.

    Article  CAS  PubMed  Google Scholar 

  13. Cooper C: The crippling consequences of fractures and their impact on quality of life. Am J Med 1997, 103:12S–17S.

    Article  CAS  PubMed  Google Scholar 

  14. Cummings SR, Melton LJ: Epidemiology and outcomes of osteoporotic fractures. Lancet 2002, 359:1761–1767.

    Article  PubMed  Google Scholar 

  15. National Osteoporosis Foundation: America’s Bone Health: The State of Osteoporosis and Low Bone Mass in Our Nation. Washington, DC: National Osteoporosis Foundation; 2002.

    Google Scholar 

  16. Kanis JA, McCloskey EV, Johansson H, et al.: A reference standard for the description of osteoporosis. Bone 2008, 42:467–475.

    Article  CAS  PubMed  Google Scholar 

  17. Looker AC, Johnston CC Jr, Wahner HW, et al.: Prevalence of low femoral bone density in older U.S. women from NHANES III. J Bone Miner Res 1995, 10:796–802.

    Article  CAS  PubMed  Google Scholar 

  18. Looker AC, Orwoll ES, Johnston CC Jr, et al.: Prevalence of low femoral bone density in older U.S. adults from NHANES III. J Bone Miner Res 1997, 12:1761–1768.

    Article  CAS  PubMed  Google Scholar 

  19. •• Looker AC, Flegal KM, Melton LJ 3rd: Impact of increased overweight on the projected prevalence of osteoporosis in older women. Osteoporos Int 2007, 18:307–313. This is the latest in several studies by Looker and colleagues using the Third National Health and Nutrition Examination Survey to estimate the prevalence of osteoporosis. Here the authors examined the potentially moderating effect of increased obesity rates on the prevalence of osteoporosis. Although they found evidence of a positive relationship between body mass index and BMD, they concluded that rising obesity (ceteris paribus) will not lead to a significant reduction in osteoporosis prevalence.

    Article  CAS  PubMed  Google Scholar 

  20. Ivers RQ, Cumming RG, Mitchell P, Peduto AJ: The accuracy of self-reported fractures in older people. J Clin Epidemiol 2002, 55:452–457.

    Article  PubMed  Google Scholar 

  21. Burge RT, King AB, Balda E, Worley D: Methodology for estimating current and future burden of osteoporosis in state populations: application to Florida in 2000 through 2025. Value Health 2003, 6:574–583.

    Article  PubMed  Google Scholar 

  22. Siggeirsdottir K, Aspelund T, Sigurdsson G, et al.: Inaccuracy in self-report of fractures may underestimate association with health outcomes when compared with medical record based registry. Eur J Epidemiol 2007, 22:631–639.

    Article  PubMed  Google Scholar 

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

    Article  CAS  PubMed  Google Scholar 

  24. Melton LJ 3rd, Thamer M, Ray NF, et al.: Fractures attributable to osteoporosis: report from the National Osteoporosis Foundation. J Bone Miner Res 1997, 12:16–23.

    Article  PubMed  Google Scholar 

  25. Baron JA, Karagas M, Barrett J, et al.: Basic epidemiology of fractures of the upper and lower limb among Americans over 65 years of age. Epidemiology 1996, 7:612–618.

    Article  CAS  PubMed  Google Scholar 

  26. Barrett JA, Baron JA, Karagas MR, Beach ML: Fracture risk in the U.S. Medicare population. J Clin Epidemiol 1999, 52:243–249.

    Article  CAS  PubMed  Google Scholar 

  27. Curtis JR, Mudano AS, Solomon DH, et al.: Identification and validation of vertebral compression fractures using administrative claims data. Med Care 2009, 47:69–72.

    Article  PubMed  Google Scholar 

  28. •• Cheng H, Gary LC, Curtis JR, et al.: Estimated prevalence and patterns of presumed osteoporosis among older Americans based on Medicare data. Osteoporos Int 2009, 20:1507–1515. This study used Medicare claims data to estimate the prevalence of osteoporosis. The authors’ case definition relied on a diagnosis code for osteoporosis or a qualifying claim for an osteoporosis-related fracture. The prevalence estimates are similar to those obtained using direct BMD measurement and suggest that administrative claims data provide an opportunity to track prevalence within detailed subpopulations.

    Article  CAS  PubMed  Google Scholar 

  29. Ray NF, Chan JK, Thamer M, Melton LJ 3rd: Medical expenditures for the treatment of osteoporotic fractures in the United States in 1995: report for the National Osteoporosis Foundation. J Bone Miner Res 1997, 12:24–35.

    Article  CAS  PubMed  Google Scholar 

  30. Hoerger TJ, Downs KE, Lakshmanan MC, et al.: Healthcare use among U.S. women aged 45 and older: total costs and costs for selected postmenopausal health risks. J Womens Health Gend Based Med 1999, 8:1077–1089.

    CAS  PubMed  Google Scholar 

  31. Chrischilles E, Shireman T, Wallace R: Costs and health effects of osteoporosis fractures. Bone 1994, 15:377–386.

    Article  CAS  PubMed  Google Scholar 

  32. Phillips S, Fox N, Jacobs J, Wright WE: The direct medical costs of osteoporosis for American women aged 45 and older. Bone 1986, 9:271–279.

    Article  Google Scholar 

  33. Rice DP, Hodgson TA, Kopstein AN: The economic costs of illness: a replication and update. Health Care Financ Rev 1985, 7:61–80.

    CAS  PubMed  Google Scholar 

  34. Sasser AC, Rousculp MD, Birnbaum HG, et al.: Economic burden of osteoporosis, breast cancer and cardiovascular disease among postmenopausal women in an employed population. Womens Health Issues 2005, 15:97–108.

    Article  PubMed  Google Scholar 

  35. Dawson KG, Gomes D, Gerstein H, et al.: The economic cost of diabetes in Canada. Diabetes Care 2002, 25:1303–1307.

    Article  PubMed  Google Scholar 

  36. Hogan P, Dall T, Nikolov P; American Diabetes Association: Economic costs of diabetes in the U.S. in 2002. Diabetes Care 2003, 26:917–932.

    Article  PubMed  Google Scholar 

  37. Bass E, French DD, Bradham DD, Rubenstein LZ: Risk-adjusted mortality rates of elderly veterans with hip fractures. Ann Epidemiol 2007, 17:514–519.

    Article  PubMed  Google Scholar 

  38. Titler M, Dochterman J, Kim T, et al.: Cost of care for seniors hospitalized for hip fracture and related procedures. Nurs Outlook 2007, 55:5–14.

    Article  PubMed  Google Scholar 

  39. Roudsari BS, Ebel BE, Corso PS, et al.: The acute medical care costs of fall-related injuries among the U.S. older adults. Injury 2005, 36:1316–1322.

    Article  PubMed  Google Scholar 

  40. Rousculp MD, Long SR, Wang S, et al.: Economic burden of osteoporosis-related fractures in Medicaid. Value Health 2007, 10:144–152.

    Article  PubMed  Google Scholar 

  41. Gabriel SE, Tosteson AN, Leibson CL, et al.: Direct medical costs attributable to osteoporotic fractures. Osteoporos Int 2002, 13:323–330.

    Article  CAS  PubMed  Google Scholar 

  42. De Laet CE, von Hout BA, Burger H, et al.: Incremental cost of medical care after hip fracture and first vertebral fracture: the Rotterdam study. Osteoporos Int 1999, 10:66–72.

    Article  PubMed  Google Scholar 

  43. •• Kilgore ML, Morrisey MA, Becker DJ, et al.: Health care expenditures associated with skeletal fractures among Medicare beneficiaries, 1999–2005. J Bone Miner Res 2009, 24:2050–2055. This article used Medicare claims data to estimate the costs associated with osteoporosis-related fractures. The authors used person-specific changes in total expenditures in the 6 months before and after incident fractures to estimate the average incremental cost for each fracture site.

    Article  PubMed  Google Scholar 

  44. Lönnroos E, Kautiainen H, Sund R, et al.: Utilization of inpatient care before and after hip fracture: a population-based study. Osteoporos Int 2009, 20:879–886.

    Article  PubMed  Google Scholar 

  45. Buntin MB, Garten AD, Paddock S, et al.: How much is postacute care affected by its availability? Health Serv Res 2005, 40:413–434.

    Article  PubMed  Google Scholar 

  46. Schneider EL, Guralnik JM: The aging of America: impact on health care costs. JAMA 1990, 263:2335–2340.

    Article  CAS  PubMed  Google Scholar 

  47. Gallagher TC, Geling O, Comite F: Missed opportunities for prevention of osteoporotic fracture. Arch Intern Med 2002, 162:450–456.

    Article  PubMed  Google Scholar 

  48. Ettinger MP: Aging bone and osteoporosis: strategies for preventing fractures in the elderly. Arch Intern Med 2003, 163:2237–2246.

    Article  PubMed  Google Scholar 

  49. Gallagher AM, Rietbrock S, Olson M, van Staa T: Fracture outcomes related to persistence and compliance with oral bisphosphonates. J Bone Miner Res 2008, 23:1569–1575.

    Article  PubMed  Google Scholar 

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Disclosure

Drs. Becker, Kilgore, and Morrisey all have received a research grant from Amgen.

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Authors and Affiliations

  1. Department of Health Care Organization and Policy, University of Alabama at Birmingham School of Public Health, RPHB 330, 1530 3rd Avenue South, Birmingham, AL, 35294-0022, USA

    David J. Becker, Meredith L. Kilgore & Michael A. Morrisey

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  1. David J. Becker
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  2. Meredith L. Kilgore
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  3. Michael A. Morrisey
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Correspondence to David J. Becker.

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Becker, D.J., Kilgore, M.L. & Morrisey, M.A. The Societal Burden of Osteoporosis. Curr Rheumatol Rep 12, 186–191 (2010). https://doi.org/10.1007/s11926-010-0097-y

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