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ARS Home » Northeast Area » Boston, Massachusetts » Jean Mayer Human Nutrition Research Center On Aging » Research » Publications at this Location » Publication #229763
Title: Inter-state Variation in the Burden of Fragility Fractures

Author
item KING, ALISON - PROCTER AND GAMBLE
item TOSTESON, ANNA - DARTMOUTH
item WONG, JOHN - TUFTS MEDICAL CENTER
item SOLOMON, DANIEL - HARVARD
item BURGE, RUSSEL - ABBOTT LABORATORIES
item Dawson-Hughes, Bess

Submitted to: Journal of Bone and Mineral Research
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 12/5/2008
Publication Date: 4/1/2009
Citation: King, A.B., Tosteson, A.N., Wong, J.B., Solomon, D.H., Burge, R.T., Dawson-Hughes, B. 2009. Inter-state Variation in the Burden of Fragility Fractures. Journal of Bone and Mineral Research. 24:681-692.

Interpretive Summary: Aging of the US population will increase the societal burden of diseases like osteoporosis that disproportionately affect the elderly. If current medical practice patterns continue, the direct medical cost of osteoporosis is projected to increase by nearly 50% from 2005 to 2025, reaching $25 billion for incident fractures. These estimates reflect the marked demographic changes expected over the next 2 decades. The US population aged 65 and older is predicted to increase 104% from 2000 to 2030, reaching 71.4 million and the largest increases are expected in non-white populations. Understanding regional variation in osteoporosis incidence, healthcare delivery, and fracture costs may help government and private healthcare programs plan for future resource needs, as well as target interventions to prevent or manage the disease. However, to date, little is known about the cost of osteoporosis at the state level. The present study was undertaken to describe hospital care patterns and to estimate the incidence and costs of osteoporotic fractures by race/ethnicity, age, sex, fracture type, and health service site in 5 states. A Markov decision model was used to estimate annual fracture incidence and cost for populations greater than or equal to 50 years of age for 2005–2025 in Arizona (AZ), California (CA), Florida (FL), Massachusetts (MA), and New York (NY). In 2005, projected fracture incidence rates ranged from 199 (CA) to 266 (MA) per 10,000. Total cost ranged from $270 million (AZ) to $1,434 million (CA). Men accounted for 26%-30% of costs. Across states, hip fractures constituted on average 77% of costs; "other" fractures (e.g., leg, arm), 10%; pelvic, 6%; vertebral, 5%; and wrist, 2%. By 2025, Hispanics are projected to represent 20% of fractures in AZ and CA, and Asian/Other populations to represent 27% of fractures in NY. We conclude that state initiatives to prevent fractures should include non-white populations and men, as well as white women, and should address fractures at all skeletal sites. Inter-state variation in service utilization merits further evaluation to determine efficient and effective disease management strategies.

Technical Abstract: Demographic differences may produce inter-state variation in the burden of osteoporosis. The objective of this study was to estimate the burden of fragility fractures by race/ethnicity, age, sex, and service site across 5 diverse and populous states. State inpatient databases for 2000 were used to describe hospital fracture admissions, and a Markov decision model was used to estimate annual fracture incidence and cost for populations greater than or equal to 50 years of age for 2005–2025 in Arizona (AZ), California (CA), Florida (FL), Massachusetts (MA), and New York (NY). In 2000, mean hospital charges for incident fractures varied 1.7-fold across states. For hip fracture, mean charges ranged from $16,700 (MA) to $29,500 (CA), length of stay from 5.3 days (AZ) to 8.9 days (NY), and discharge rate to long-term care from 43% (NY) to 71% (CA). In 2005, projected fracture incidence rates ranged from 199 (CA) to 266 (MA) per 10,000. Total cost ranged from $270 million (AZ) to $1,434 million (CA). Men accounted for 26%-30% of costs. Across states, hip fractures constituted on average 77% of costs; "other" fractures (e.g., leg, arm), 10%; pelvic, 6%; vertebral, 5%; and wrist, 2%. By 2025, Hispanics are projected to represent 20% of fractures in AZ and CA, and Asian/Other populations to represent 27% of fractures in NY. State initiatives to prevent fractures should include non-white populations and men, as well as white women, and should address fractures at all skeletal sites. Inter-state variation in service utilization merits further evaluation to determine efficient and effective disease management strategies.