Healthcare Costs of Osteoporotic Fracture in Korea: Information from the National Health Insurance Claims Database, 2008-2011

Timed up-and-go test is a useful predictor of fracture incidence

PURPOSE

The timed up-and-go (TUG) test is a validated screening tool to assess fall risk. This study evaluated the association between the TUG test and future fractures, which are a tangible clinical complication of falling.

METHODS

We included 1,070,320 participants who participated in the National Screening Program for Transitional Ages for Koreans aged 66 years old from 2009 to 2014. Among them, 355,753 women underwent dual-energy X-ray absorptiometry. TUG times were classified as <10 s or ≥10 s. The incidence of fractures, including vertebral, hip, and other sites, was determined using claims data from the National Health Information database.

RESULTS

During the mean follow-up period of 4.4 ± 1.8 years, participants with slow TUG times had a significantly increased risk of fractures compared with those who had normal TUG times: any fractures (adjusted hazard ratio [aHR] = 1.08, 95% confidence interval [CI] = 1.06-1.10), vertebral fracture (aHR = 1.14, 95% CI = 1.11-1.16), hip fracture (aHR = 1.21, 95% CI = 1.13-1.29), and other fractures (upper arm, forearm, and lower leg; aHR = 1.02, 95% CI = 1.00-1.05). Among women with bone mineral density (BMD) results, slow TUG performance was associated with an increased risk of fracture independent of BMD.

CONCLUSIONS

The TUG test, as an indicator of physical performance, can provide information about future fracture risk above that provided by BMD. Conducting the TUG test to assess fracture risk should be considered to improve fracture risk assessment and propose interventions to improve physical performance, thereby reducing fracture risk.

Anemia and Risk of Fractures in Older Korean Adults: A Nationwide Population-Based Study

Anemia is a common health problem in older adults and is associated with risk factors for fracture such as low physical function and low bone mass. The aim of this study was to examine the relationship between anemia and fracture risk in older adults. We conducted a retrospective cohort study from 2003 to 2013. The participants were community-dwelling Korean adults aged 65 years and older who participated in the National Health Screening Program (n = 72,131) between 2003 and 2008. Anemia (<12 g/dL for women and <13 g/dL for men) and severity of anemia (mild: 11 g/dL ≤ Hb < 12 g/dL; moderate to severe: Hb < 11 g/dL) were defined by World Health Organization (WHO) criteria. The incidence of any fractures, vertebral fractures, and femur fractures was identified using ICD-10 codes. Cox proportional hazard regression models were used to assess risk of fracture according to anemia. Anemia was associated with increased risk of fracture in men (any: adjusted hazard ratio [aHR] = 1.29, 95% confidence interval [CI] 1.18-1.41; vertebral: aHR = 1.20, 95% CI 1.03-1.40; femur: aHR = 1.71, 95% CI 1.44-2.04), and less strongly but still significantly in women (any: aHR = 1.10, 95% CI 1.11-1.41; vertebral: aHR = 1.11, 95% CI 1.03-1.20; femur: aHR = 1.37, 95% CI 1.25-1.52). Higher risk was observed in subjects with moderate-to-severe anemia in both sexes. Considering the high prevalence of anemia in older adults, it is important that health professionals recognize increased fracture risk in older adults with anemia. © 2019 American Society for Bone and Mineral Research.

Concerns for Older Adult Patients with Acute Hip Fracture

PURPOSE

The purpose of this study was to identify concerns among older adult patients with acute hip fracture.

MATERIALS AND METHODS

This study was performed with 152 consecutive patients with hip fracture. Details were obtained on perioperative concerns about hip fracture using a questionnaire that was specifically designed for this study and was administered face to face upon admission. The study inclusion criteria were age older than 65 years and having experienced femur neck, intertrochanteric, or subtrochanteric fracture. The exclusion criteria were not understanding the study purpose, having difficulty communicating, or refusing to participate.

RESULTS

Older adult patients with acute hip fracture expressed concerns regarding excessive pain, medical staff, postoperative recovery, rehabilitation, and hospital expenses. In addition, fear of falling from the bed and anxiety regarding re-fracture were the patients' most significant concerns.

CONCLUSION

Older adult patients reported fear of falling from bed and re-fracture as primary concerns. To overcome these concerns, fracture liaison services to prevent re-fracture should be introduced and enforced.

Urinary Incontinences Are Related with Fall and Fragility Fractures in Elderly Population: Nationwide Cohort Study

Background

This prospective cohort study used nationwide claims data to investigate the incidence of fall and fragility fractures in association with urinary incontinence (UI) in the elderly, and to compare mortality after fragility fractures in elderly patients with or without incontinence.

Methods

A total of 39,854 Korean adults (age, 66-80 years) who participated in health examinations between 2007 and 2012 and were followed up until 2015 were analyzed. Patient and comparison groups were classified according to the presence or absence of UI. The cumulative incidence of osteoporotic fragility fractures and falls in the 2 groups was assessed and compared. Hazard ratios for fragility fractures were calculated for the risk of UI in association with falls using a Cox proportional hazards model.

Results

Of 39,854 elderly participants, 5,703 were classified in the UI group, while 34,151 were placed in the comparison group. Fall rates were significantly higher (20.8%) in the incontinence group than in the comparison group (4.7%) (P<0.001). Women in the incontinence group (13.9%) showed a significantly higher incidence of all types of fragility fractures than those in the comparison group (11.8%) (P=0.005). After adjustment for confounders, UI was not a significant risk factor for fragility fractures in men (P=0.878) or women (P=0.324).

Conclusions

This study demonstrated that elderly women with UI have a significantly higher incidence of osteoporotic fragility fractures. In addition, elderly women are at higher risk for falls.

Relationship between Bone Density, Eating Habit, and Nutritional Intake in College Students

Background

The importance of bone health is emphasized throughout the life cycle. Young adults have problems with bone health due to irregular lifestyle and unbalanced diet, but studies related to them are insufficient. The purpose of this study was to measure the bone mineral density (BMD) of college students and to analyze the differences in BMD according to lifestyle.

Methods

BMD was measured by bone ultrasound in 161 male and female college students. The questionnaire was surveyed about lifestyle, eating habits, and nutrient intake status.

Results

Osteopenia was 8.8% in male and 10.8% in female. The body fat percentage of female was significantly higher than male. Male college students, smoking, fast food consumption, and overeating rate were significantly higher than female. Nutrient intake was not significantly different between male and female students. But energy and vitamin A and C levels were inadequate, and protein and sodium intake was excessive compared with the recommended nutrient intake for Koreans. BMD was significantly lowest in male who often intake fast food than male who did not intake at all or intake sometimes. Female who often intake fast food had significantly lower BMD than female who did not eat at all.

Conclusions

College students have different BMDs according to lifestyle. There was a difference in BMD according to smoking and fast food consumption.

Effect of improved medication adherence on health care costs in osteoporosis patients

Osteoporosis is a chronic disease that requires continuous health care spending for pharmacotherapy and examinations. Osteoporotic fractures are a major economic burden. However, little is known about the economic effects of osteoporosis and osteoporotic fractures in Korea.The purpose of this study was to determine the predictors of osteoporosis-related health care costs and to evaluate the economic effects of fracture prevention through medication adherence among osteoporosis patients.Using the Korea National Health Insurance Claims Database (KNHICD), we identified osteoporosis patients aged 50 years and older from 2011 to 2012. Annual health care costs of osteoporosis were analyzed from the insurer's perspective and compared between patients with fractures and those without fractures. Adherents were defined as patients with a medication possession ratio of ≥80%. A generalized linear model (GLM) was used to estimate the predictors of osteoporosis-related health care costs.The major predictors of osteoporosis-related health care costs were age, medication adherence, and the occurrence of fractures (P < .001). The proportion of fractures among non-adherents was approximately 1.1 times the proportion among adherents. Health care costs per patient with fractures were 3.8 times the costs per patient without fractures. Patients with fractures had higher health care costs due to hospitalization and outpatient costs but lower pharmacy costs than non-adherents. We estimated that about $5 million of health insurance expenses could be saved annually if all non-adherents became adherents.Improved osteoporosis medication adherence can reduce osteoporosis-related health care costs by preventing fractures. Persistent pharmacotherapy for osteoporosis is necessary to prevent osteoporotic fractures and to reduce osteoporosis-related health care costs.

Hospitalisation cost analysis on hip fracture in China: a multicentre study among 73 tertiary hospitals

OBJECTIVE

To describe and analyse the hospitalisation cost of patients with hip fracture under the influence of various factors and to provide references for Chinese national medical insurance policy.

MATERIALS AND METHODS

All data were collected from the Chinese National Medical Data Centre database, which contained the hospitalisation data of 73 tertiary hospitals from 24 provinces. The included patients were first hospitalised with the main diagnosis of femoral neck or intertrochanteric fracture, and were discharged between 1 January 2014 and 31 December 2015. Secondary hospitalisation, multiple trauma or pathologic fracture (except for osteoporotic fracture) patients or patients with missing data were excluded. The impact of various factors on the cost was investigated using analysis of variance and multivariable linear regression analysis. The Gross Domestic Product per capita and average annual disposable income were obtained from the website of the National Bureau of Statistics.

RESULTS

27 205 cases were included in the study. The mean cost of all patients was ¥53 440. 60-69 years age group had a significantly higher cost compared with 80 years and above age group. The mean cost of femoral neck fractures was lower than that of the patients with intertrochanteric fractures; the mean cost of hip replacement was higher than that of internal fixation, which showed a strong effect of the surgical approach to the cost. Patients in low-income provinces spent less than those in high-income provinces, while the gap between high-income and middle-income provinces were relatively small.

CONCLUSION

The hospitalisation cost of hip fracture has become a great burden to the patients' families. The Chinese medical insurance policy may need further consideration of the demographic and economic factors.