Direct medical resource utilization associated with osteoporosis-related nonvertebral fractures in postmenopausal women

Abstract

The purposes of this study were to assess direct medical resource utilization related to the treatment of nonvertebral osteoporotic fractures within 1 year postfracture and to evaluate whether age impacts resource utilization. A previously-validated algorithm for physician claims databases identified 15,327 women aged 50 years or older with incident fracture at nonvertebral osteoporotic sites between January 1, 2004 and December 31, 2005. Administrative databases of the health services available to all residents in Quebec served to study fracture-related health resource utilization in the year after fracture. Data were linked by a unique personal identifier, creating a longitudinal cohort of all fracture cases for health resource utilization. The proportions of fractures treated by open reduction, closed reduction, immobilization or follow-up by an orthopedic surgeon (OS) were evaluated. The mean number of claims for consultation with an OS or other clinicians in inpatient and outpatient visits, the hospitalization rate and length of stay (LOS) were assessed. Hip/femur fractures represented the highest rate of resource utilization because the majority of them required surgery (91.1%) and hospitalization (94.5%) with a mean (median) LOS of 39.2 (31) days. However, other nonvertebral fracture types needed significant clinical care related to surgery (27.9%), follow-up consultation with an OS (77.6%), and hospitalization (27.3% of total LOS). Even pelvic fractures, which often do not require surgical treatment, commanded high resource utilization due to the high hospitalization rate (67.4%) with mean (median) LOS of 34.2 (26) days. Moreover, age was an important determinant of health resource utilization, being associated with an increased number of visits to other physicians, hospitalization, and length of hospitalization (LOS), admissions to long term care (LTC), and death. Osteoporosis-related fractures accounted for substantial healthcare resource utilization. With an aging population and increased prevalence of fractures, strategies for osteoporosis management need to be introduced to reduce the healthcare burden. ß

Pelvic fractures: epidemiology, consequences, and medical management

“…For example, in the study of Marrinan et al [16 && ], on admission to hospital, 89% of patients lived independently, but at the point of discharge from hospital, this figure dropped to 64% and the odds of changing from independent to institutionalized accommodation were significantly associated with age and length of hospital stay. In another study [22], 25.4% of patients discharge to rehabilitation or community health services centers and 10.9% to long-term care. Clement et al [19] reported that patients who were independently mobile or less socially deprived were more likely to return to their original domicile.…”

“…Although these fractures often do not require a surgical treatment, they lead to hospitalization in 67.4% of the cases with a mean stay length of 34.2 days [22]. Indeed, pelvic fractures lead to decreased mobility and loss of independence, which determine the hospital stay length and the discharge type.…”

Evaluation of risk factors for fractures in postmenopausal women with osteoporosis

“…A vizsgálat meglepetéseként szolgált, hogy a töröttek között csaknem 10%-ban a csípőtáji töröttek is reprezentálva voltak, pedig a nemzetközi irodalmi adatok szerint ezen betegek az ambuláns rendeléseket ritkábban látogatják, avagy kevésbé képesek a járóbeteg-szakellátást felkeresni [23].…”

Screening, assessment, and treatment of osteoporosis for the nurse practitioner: Key questions and answers for clinical practice—A Canadian perspective

“…The impact of a fragility fracture on a patient's quality of life is notable, with approximately 40% of women over the age of 50, who have had a hip fracture requiring assistance with ambulation 1 year after the fracture (Cooper, ), and 18% requiring long‐term care following hospitalization (Jean et al., ). Fractures have both morbidity and mortality consequences.…”