Mayo Clinic Proceedings Home

Burden of Illness for Osteoporotic Fractures Compared With Other Serious Diseases Among Postmenopausal Women in the United States

Published:December 03, 2014DOI:https://doi.org/10.1016/j.mayocp.2014.09.011

      Abstract

      Objectives

      To provide a national estimate of the incidence of hospitalizations due to osteoporotic fractures (OFs) in women; compare this with the incidence of myocardial infarction (MI), stroke, and breast cancer; and assess temporal trends in the incidence and length of hospitalizations.

      Patients and Methods

      The study included all women 55 years and older at the time of admission, admitted to a hospital participating in the US Nationwide Inpatient Sample for an outcome of interest. We performed a retrospective analysis of hospitalizations for OFs (hip, forearm, spine, pelvis, distal femur, wrist, and humerus), MI, stroke, or breast cancer, using the US Nationwide Inpatient Sample, 2000-2011.

      Results

      From 2000 to 2011, there were 4.9 million hospitalizations for OF, 2.9 million for MI, 3.0 million for stroke, and 0.7 million for breast cancer. Osteoporotic fractures accounted for more than 40% of the hospitalizations in these 4 outcomes, with an age-adjusted rate of 1124 admissions per 100,000 person-years. In comparison, MI, stroke, and breast cancer had age-adjusted incidence rates of 668, 687, and 151 admissions per 100,000 person-years, respectively. The annual total population facility-related hospital cost was highest for hospitalizations due to OFs ($5.1 billion), followed by MI ($4.3 billion), stroke ($3.0 billion), and breast cancer ($0.5 billion).

      Conclusion

      These data provide evidence that in US women 55 years and older, the hospitalization burden of OFs and population facility-related hospital cost is greater than that of MI, stroke, or breast cancer. Prioritization of bone health and supporting programs such as fracture liaison services is needed to reduce this substantial burden.

      Abbreviations and Acronyms:

      MI ( myocardial infarction), NIS ( Nationwide Inpatient Sample), NHDS ( National Hospital Discharge Survey)
      To read this article in full you will need to make a payment

      References

        • US Department of Health and Human Services
        Bone Health and Osteoporosis: A Report of the Surgeon General.
        Office of the Surgeon General, Rockville, MD2004
        • Burge R.
        • Dawson-Hughes B.
        • Solomon D.H.
        • Wong J.B.
        • King A.
        • Tosteson A.
        Incidence and economic burden of osteoporosis-related fractures in the United States, 2005-2025.
        J Bone Miner Res. 2007; 22: 465-475
        • Boonen S.
        • Autier P.
        • Barette M.
        • Vanderschueren D.
        • Lips P.
        • Haentjens P.
        Functional outcome and quality of life following hip fracture in elderly women: a prospective controlled study.
        Osteoporos Int. 2004; 15: 87-94
        • Brenneman S.K.
        • Barrett-Connor E.
        • Sajjan S.
        • Markson L.E.
        • Siris E.S.
        Impact of recent fracture on health-related quality of life in postmenopausal women.
        J Bone Miner Res. 2006; 21: 809-816
        • Chrischilles E.A.
        • Butler C.D.
        • Davis C.S.
        • Wallace R.B.
        A model of lifetime osteoporosis impact.
        Arch Intern Med. 1991; 151 (Erratum in: Arch Intern Med. 1922;152(3):655): 2026-2032
        • van Staa T.P.
        • Dennison E.M.
        • Leufkens H.G.
        • Cooper C.
        Epidemiology of fractures in England and Wales.
        Bone. 2001; 29: 517-522
      1. NCI. Breast cancer risk in American women. 2012. http://www.cancer.gov/cancertopics/factsheet/detection/probability-breast-cancer. Accessed August 4, 2013.

        • Gerend M.A.
        • Aiken L.S.
        • West S.G.
        • Erchull M.J.
        Beyond medical risk: investigating the psychological factors underlying women’s perceptions of susceptibility to breast cancer, heart disease, and osteoporosis.
        Health Psychol. 2004; 23: 247-258
        • Siris E.S.
        • Gehlbach S.
        • Adachi J.D.
        • et al.
        Failure to perceive increased risk of fracture in women 55 years and older: the Global Longitudinal Study of Osteoporosis in Women (GLOW).
        Osteoporos Int. 2011; 22: 27-35
        • Kasper M.J.
        • Peterson M.G.
        • Allegrante J.P.
        • Galsworthy T.D.
        • Gutin B.
        Knowledge, beliefs, and behaviors among college women concerning the prevention of osteoporosis.
        Arch Fam Med. 1994; 3: 696-702
        • Rozenberg S.
        • Twagirayezu P.
        • Paesmans M.
        • Ham H.
        Perception of osteoporosis by Belgian women who work in a university hospital.
        Osteoporos Int. 1999; 10: 312-315
        • Sale J.E.
        • Beaton D.E.
        • Bogoch E.R.
        • Elliot-Gibson V.
        • Frankel L.
        The BMD muddle: the disconnect between bone densitometry results and perception of bone health.
        J Clin Densitom. 2010; 13: 370-378
        • Giangregorio L.
        • Papaioannou A.
        • Thabane L.
        • et al.
        Do patients perceive a link between a fragility fracture and osteoporosis?.
        BMC Musculoskelet Discord. 2008; 9: 38
        • Gregson C.L.
        • Dennison E.M.
        • Compston J.E.
        • et al.
        Disease-specific perception of fracture risk and incident fracture rates: GLOW cohort study.
        Osteoporos Int. 2014; 25: 85-95
        • Gold E.B.
        • Crawford S.L.
        • Avis N.E.
        • et al.
        Factors related to age at natural menopause: longitudinal analyses from SWAN.
        Am J Epidemiol. 2013; 178: 70-83
      2. US Census Bureau. Current population survey. 2012. http://www.census.gov/cps/. Accessed November 4, 2013.

        • Stevens J.A.
        • Anne Rudd R.
        Declining hip fracture rates in the United States.
        Age Ageing. 2010; 39: 500-503
        • Ettinger B.
        • Black D.M.
        • Dawson-Hughes B.
        • Pressman A.R.
        • Melton III, L.J.
        Updated fracture incidence rates for the US version of FRAX.
        Osteoporos Int. 2010; 21: 25-33
        • Fang J.
        • Alderman M.H.
        • Keenan N.L.
        • Ayala C.
        Acute myocardial infarction hospitalization in the United States, 1979 to 2005.
        Am J Med. 2010; 123: 259-266
        • Fang J.
        • Alderman M.H.
        • Keenan N.L.
        • Croft J.B.
        Declining US stroke hospitalization since 1997: National Hospital Discharge Survey, 1988-2004.
        Neuroepidemiology. 2007; 29: 243-249
        • Lippuner K.
        • Grifone S.
        • Schwenkglenks M.
        • et al.
        Comparative trends in hospitalizations for osteoporotic fractures and other frequent diseases between 2000 and 2008.
        Osteoporos Int. 2012; 23: 829-839
        • Watts N.B.
        • Bilezikian J.P.
        • Camacho P.M.
        • et al.
        • AACE Osteoporosis Task Force
        American Association of Clinical Endocrinologists Medical Guidelines for Clinical Practice for the diagnosis and treatment of postmenopausal osteoporosis.
        Endocr Pract. 2010; 16: 1-37
        • Cauley J.A.
        • Wampler N.S.
        • Barnhart J.M.
        • et al.
        • Women’s Health Initiative Observational Study
        Incidence of fractures compared to cardiovascular disease and breast cancer: the Women’s Health Initiative Observational Study.
        Osteoporos Int. 2008; 19: 1717-1723
      3. Avalere Health AHA. Trendwatch Chartbook 2013: Trends Affecting Hospitals and Health Systems. American Hospital Association; 2013.

        • Chen J.
        • Normand S.L.
        • Wang Y.
        • Drye E.E.
        • Schreiner G.C.
        • Krumholz H.M.
        Recent declines in hospitalizations for acute myocardial infarction for Medicare fee-for-service beneficiaries: progress and continuing challenges.
        Circulation. 2010; 121: 1322-1328
        • Downing A.
        • Lansdown M.
        • West R.M.
        • Thomas J.D.
        • Lawrence G.
        • Forman D.
        Changes in and predictors of length of stay in hospital after surgery for breast cancer between 1997/98 and 2004/05 in two regions of England: a population-based study.
        BMC Health Serv Res. 2009; 9: 202
        • Wang O.J.
        • Wang Y.
        • Chen J.
        • Krumholz H.M.
        Recent trends in hospitalization for acute myocardial infarction.
        Am J Cardiol. 2012; 109: 1589-1593
        • Christensen L.
        • Iqbal S.
        • Macarios D.
        • Badamgarav E.
        • Harley C.
        Cost of fractures commonly associated with osteoporosis in a managed-care population.
        J Med Econ. 2010; 13: 302-313
        • Shi N.
        • Foley K.
        • Lenhart G.
        • Badamgarav E.
        Direct healthcare costs of hip, vertebral, and non-hip, non-vertebral fractures.
        Bone. 2009; 45: 1084-1090
        • Ioannidis G.
        • Flahive J.
        • Pickard L.
        • et al.
        • GLOW Investigators
        Non-hip, non-spine fractures drive healthcare utilization following a fracture: the Global Longitudinal Study of Osteoporosis in Women (GLOW).
        Osteoporos Int. 2013; 24: 59-67
        • Ray W.A.
        • Griffin M.R.
        • Fought R.L.
        • Adams M.L.
        Identification of fractures from computerized Medicare files.
        J Clin Epidemiol. 1992; 45: 703-714
        • Dimai H.P.
        • Svedbom A.
        • Fahrleitner-Pammer A.
        • et al.
        Epidemiology of proximal humeral fractures in Austria between 1989 and 2008.
        Osteoporos Int. 2013; 24: 2413-2421
        • Baron J.A.
        • 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
      4. US Centers for Disease Control and Prevention. Incidence and costs to Medicare of fractures among Medicare beneficiaries aged 65 years – United States, July 1991-June 1992. Morb Mortal Wkly Rep. 1996;(41):877-883.

        • Port L.
        • Center J.
        • Briffa N.K.
        • Nguyen T.
        • Cumming R.
        • Eisman J.
        Osteoporotic fracture: missed opportunity for intervention.
        Osteoporos Int. 2003; 14: 780-784
        • Eisman J.A.
        • Bogoch E.R.
        • Dell R.
        • et al.
        • ASBMR Task Force on Secondary Fracture Prevention
        Making the first fracture the last fracture: ASBMR task force report on secondary fracture prevention.
        J Bone Miner Res. 2012; 27: 2039-2046
        • Lih A.
        • Nandapalan H.
        • Kim M.
        • et al.
        Targeted intervention reduces refracture rates in patients with incident non-vertebral osteoporotic fractures: a 4-year prospective controlled study.
        Osteoporos Int. 2011; 22: 849-858
        • Majumdar S.R.
        • Beaupre L.A.
        • Harley C.H.
        • et al.
        Use of a case manager to improve osteoporosis treatment after hip fracture: results of a randomized controlled trial.
        Arch Intern Med. 2007; 167: 2110-2115
        • Jennings L.A.
        • Auerbach A.D.
        • Maselli J.
        • Pekow P.S.
        • Lindenauer P.K.
        • Lee S.J.
        Missed opportunities for osteoporosis treatment in patients hospitalized for hip fracture.
        J Am Geriatr Soc. 2010; 58: 650-657
        • Tosi L.L.
        • Gliklich R.
        • Kannan K.
        • Koval K.J.
        The American Orthopaedic Association’s “own the bone” initiative to prevent secondary fractures.
        J Bone Joint Surg Am. 2008; 90: 163-173
        • Feldstein A.C.
        • Nichols G.A.
        • Elmer P.J.
        • Smith D.H.
        • Aickin M.
        • Herson M.
        Older women with fractures: patients falling through the cracks of guideline-recommended osteoporosis screening and treatment.
        J Bone Joint Surg Am. 2003; 85-A: 2294-2302
        • Feldstein A.
        • Elmer P.J.
        • Orwoll E.
        • Herson M.
        • Hillier T.
        Bone mineral density measurement and treatment for osteoporosis in older individuals with fractures: a gap in evidence-based practice guideline implementation.
        Arch Intern Med. 2003; 163: 2165-2172
        • Solomon D.H.
        • Finkelstein J.S.
        • Katz J.N.
        • Mogun H.
        • Avorn J.
        Underuse of osteoporosis medications in elderly patients with fractures.
        Am J Med. 2003; 115: 398-400
        • Gallagher T.C.
        • Geling O.
        • Comite F.
        Missed opportunities for prevention of osteoporotic fracture.
        Arch Intern Med. 2002; 162: 450-456
        • Cuddihy M.T.
        • Gabriel S.E.
        • Crowson C.S.
        • et al.
        Osteoporosis intervention following distal forearm fractures: a missed opportunity?.
        Arch Intern Med. 2002; 162: 421-426
        • Bahl S.
        • Coates P.S.
        • Greenspan S.L.
        The management of osteoporosis following hip fracture: have we improved our care?.
        Osteoporos Int. 2003; 14: 884-888