Fractures Attributable to Osteoporosis: Report from the National Osteoporosis Foundation

TLDR

Secondary database diagnosis codes can estimate treatment resources for many diseases, but they do not distinguish osteoporotic fractures. To evaluate the cost‑effectiveness of osteoporosis‑prevention interventions, the authors estimate total direct medical costs for osteoporotic fractures using derived attribution probabilities. A Delphi panel of experts estimated osteoporosis‑attribution probabilities for 72 fracture categories—hip, spine, forearm, and all other sites—across age, gender, and race strata, using a three‑round consensus process. The study found that at least 90 % of hip and spine fractures in elderly white women are attributable to osteoporosis, while other fracture types have much lower attribution rates, and men and non‑whites consistently show lower probabilities than women and whites.

Abstract

To assess the cost-effectiveness of interventions to prevent osteoporosis, it is necessary to estimate total health care expenditures for the treatment of osteoporotic fractures. Resources utilized for the treatment of many diseases can be estimated from secondary databases using relevant diagnosis codes, but such codes do not indicate which fractures are osteoporotic in nature. Therefore, a panel of experts was convened to make judgments about the probabilities that fractures of different types might be related to osteoporosis according to patient age, gender, and race. A three-round Delphi process was applied to estimate the proportion of fractures related to osteoporosis (i.e., the osteoporosis attribution probabilities) in 72 categories comprised of four specific fracture types (hip, spine, forearm, all other sites combined) stratified by three age groups (45-64 years, 65-84 years, 85 years and older), three racial groups (white, black, all others), and both genders (female, male). It was estimated that at least 90% of all hip and spine fractures among elderly white women should be attributed to osteoporosis. Much smaller proportions of the other fractures were attributed to osteoporosis. Regardless of fracture type, attribution probabilities were less for men than women and generally less for non-whites than whites. These probabilities will be used to estimate the total direct medical costs associated with osteoporosis-related fractures in the United States.