Osteoporosis-Related Fracture Events in the US

Abstract

Introduction Osteoporosis is an important public health problem. Even patients who are hospitalized for fracture remain subsequently untreated. Current evidence on fracture occurrence is required to help payers and policymakers prioritize access to therapies and programs that can reduce the burden and cost of osteoporosis. Objectives To evaluate the magnitude of claims-based osteoporosis-related fractures in the US population overall and across subgroups including race/ethnicity, age, sex, and fracture site. Methods The current study used 2015 data from Medicare Standard Analytic Files (SAF), a national representation of all Medicare Fee for Service claims. In addition, commercial claim estimates were built using the following sources of data: Medicare SAF Inpatient Claims, Health Care Cost Utilization Project, CMS Hospital, US Census Bureau demographics by zip code, and commercial claims from several states. Estimates of closed fractures were quantified for hip, clinical vertebral, wrist, and other skeletal sites associated with fragility fractures that commonly occur in patients with osteoporosis using the following principal diagnosis ICD-9 codes: 805.x, 805.2x, 805.4x, 805.8x, 813.2x, 813.4x, 813.8x, 808.8x, 810.0x, 811.0x, 812.0x, 812.2x, 812.4x, 814.0x, 815.0x, 821.0x, 822.0x, 823.0x, 823.2x,823.4x, 823.8x. Results More than 2 million fractures occurred in 2015. Women accounted for 70% of fractures and 74% of the cost. Although there was a high occurrence of vertebral fractures in both men and women (18%), nonvertebral fractures represented (82%) of all fractures. They included wrist (16%), hip (20%), pelvic (7%), and other (33%; humerus, clavicle, and hand/fingers). Over 38% of the total diagnostic claims for fractures occurred in patients living in the southern region of the United States. On a state-by-state basis, Florida (8%), Texas (7%), and New York (6%) contributed to a majority of fracture events. Most fractures occurred in patients 75-84 years of age; however, the number of fracture-related claims, while steady over time compared with previous studies, remained highest in white women. Conclusions The number of osteoporosis-related fractures has escalated as predicted by earlier epidemiological studies. Treatment of osteoporosis and educational efforts in raising awareness about both osteoporosis and osteoporosis-related fractures should include all skeletal sites. Further, increased access to available therapies is warranted in the subpopulations with the highest risk.