The Economic Burden of Severe Osteoporotic Fractures in the French Healthcare Database: The FRACTOS Study

Association of hospital-initiated bone densitometry with hospitalization for fragility fracture at Lille University Hospital among adults with chronic obstructive pulmonary disease

A retrospective study was conducted to calculate the cumulative incidence of hospital-initiated bone densitometry, in the year following hospitalization for fragility fracture in patients with chronic obstructive pulmonary disease. This cohort study demonstrated low rates of hospital-initiated bone densitometry with a 1-year cumulative incidence of 22.6%.

BACKGROUND

Osteoporosis is one of the most frequent comorbidities in chronic obstructive pulmonary disease (COPD) patients. A study was conducted to assess the management of osteoporosis in COPD patients using the INCLUDE health data warehouse.

OBJECTIVES

The primary objective was to calculate the cumulative incidence of hospital-initiated bone densitometry, in the year following hospitalization for fragility fracture in COPD patients.

PATIENTS AND METHODS

A retrospective, monocentric, observational study was conducted at Lille University Hospital with patients identified from January 2013 to December 2021. Patients with COPD, aged 40 or over, and hospitalized for a fragility fracture according to the ICD-10 classification were included. Bone densitometry was indexed according to French Common Procedures Classification (CCAM) acts by INCLUDE.

RESULTS

A total of 365 patients (~ 60% male, mean age 73.5 ± 12.3 years, and median Charlson score 2.0 (1.0; 4.0)) were included. Hospitalization units for fractures were orthopedics (n = 168), geriatrics (n = 46), rheumatology (n = 45), pneumology (n = 24), and others (n = 82). A total of 499 fractures were identified, most of them severe (hip (36.4%), vertebrae (30.1%), proximal humerus (11.5%), pelvis (10.7%), etc.). During the first year, 69 patients (18.9%) died, and 81 underwent hospital-initiated bone densitometry. The cumulative incidence of bone densitometry in the 1st year was 22.6% [CI 95% 18.3-27.1%]. Independent determinants of performing bone densitometry were female gender, low Charlson score, hospitalization in rheumatology, and vertebral fracture(s).

CONCLUSION

The cumulative incidence of hospital-initiated bone densitometry, within 1 year of hospitalization for a fragility fracture in COPD patients was relatively low.

Impact of major osteoporotic fractures on the use of healthcare resources in Catalonia, Spain

OBJECTIVES

To estimate the impact of first major osteoporotic fractures (MOF) on health resource use and healthcare expenditures in people aged ≥50 years in Catalonia, Spain.

DESIGN

Observational, retrospective study. The Catalan Health Surveillance System (CHSS) registry was used to obtain sociodemographic, clinical and expenditure data from all public centres in Catalonia (Spain).

SETTING AND PARTICIPANTS

Males and females aged ≥50 years who sustained a first major osteoporotic fracture between January 1, 2018, and December 31, 2020.

METHODS

Data on admissions to the emergency department, hospitalization and skilled nursing facilities, primary and specialized care visits, nonemergency medical transport, outpatient rehabilitation and pharmacy prescriptions were retrieved for each patient. Monthly and yearly mean usage rates, expenditure in euros (€) and incremental costs one and two years after fracture were calculated.

RESULTS

There were 64,403 patients with first MOF: 47,555 females and 16,848 males with a mean age (standard deviation) of 76.5 (12.0) years. The average annual expenditure increased from €4564 in the year before to €12,331 in the year following a hip fracture. For forearm fractures, the expenditure increased from €2511 to €4251, for vertebral fractures from €4146 to €6659, for pelvic fractures from €4442 to €7124, for humerus fractures from €3058 to €5992, and for multiple fractures from €4598 to €12,028. The average cost for overall fractures experienced a 110.3 % increase. The leading cause of health expenditure in the year following MOF was hospital admission. Expenditure in the second year post-fracture returned to pre-fracture levels. The use of some healthcare resources, especially visits to emergency services, increased in the prefracture month. Male sex, older age and high previous comorbidities were associated with a higher expenditure.

CONCLUSIONS

In people with a first MOF, healthcare expenditure doubled during the first-year post-facture, mostly in relation to inpatient care. The healthcare resource use increased during the previous month. This increase could potentially be attributed to the worsening of pre-existing comorbidities.