OBJECTIVES: To evaluate osteoporosis-related fractures and associated costs in the US for the period 2005-2025.
METHODS: Base year 2005 costs and fractures for men and women aged 50-99, segmented by race/ethnicity were estimated from an osteoporosis Markov model. Fracture incidence rates were calculated from US hospital discharge data for hip fractures and from published data for all other fractures. Costs included inpatient costs from US hospital discharge data, and literature-based outpatient and long-term care costs. Annual costs and fractures were projected through 2025 using age, sex, race/ethnicity-specific US-census based population compositions for each year, fracture incidence, and costs. Race/ethnicity groups included White non-Hispanic, Black non-Hispanic, Hispanic (any race), and Other (non Hispanic Asian/Pacific Islander, Native American, and other). In sensitivity analyses, costs for prevalent fractures (from survivors of prior hip and pelvic fractures in 2000-2004) were added to the annual incident fracture costs.
RESULTS: In 2005, the model predicts 2.0 million (M) incident osteoporotic fractures in the US, costing over $16.9 billion (B). Whites account for 86% of fractures and 88% of costs. Women incur 71% of fractures and 76% of costs. Hip and vertebral fractures represent 14% and 27% of total fractures, and 71% and 6% of total costs, respectively. Wrist (19%), pelvic (7%) and other fractures (33%) combined comprise 59% of total fractures and 23% of total costs. Over the next 10 years, annual fracture incidence is estimated to rise by 22%, while annual costs increase over 20%. By race/ethnicity subpopulations, base year costs of $754 M for Hispanics, $501 M for Other, and $708 M for Blacks grow by over 73%, 68%, and 35%, respectively. By 2025, annual fractures and associated costs are projected to grow by over 48% to more than 3 M and $25.3 B, respectively. The largest rates of increase are found within the Hispanic and Other subpopulations, where annual costs grow by over 174%; annual costs increase by 79% for Blacks and 37% for Whites. Cumulative cost of incident fractures is $209 B during 2006-2015 and $228 B during 2016-2025. When costs of prevalent fractures are included, total base year costs rise by 14% to $19.3 B, and annual costs in 2025 increase from $25.3 B to $28.8 B. The combined cumulative cost of both incident and prevalent fractures is predicted to be $215 B during 2006-2015 and $259 B during 2016 -2025.
CONCLUSIONS: The economic burden of incident osteoporotic fractures in the US is projected to be almost $17 B in 2005 and $209 B over the next decade. The full cost burden of osteoporotic fractures may be over $19 B in 2005 when the ongoing costs of prevalent fractures are considered. Over the next 20 years, the non-White population will comprise a growing proportion of the number of fractures and related costs, increasing from 282,000 fractures (13% of total fractures) and $1.9 B costs (12% of total costs) in 2005, to over 637,000 fractures (21% of total) and over $4.7 B (19% of total) by 2025. The expected impacts from changing population demographics suggest that osteoporosis prevention efforts should also target diverse racial ethnic groups.
Disclosure Information:
Faculty Member's Name: Russel T. Burge, PhD
Other Financial or Material Support: Employee of Procter & Gamble Pharmaceuticals
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