Arthritis & Rheumatism, Volume 62,
November 2010 Abstract Supplement

Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Atlanta, Georgia November 6-11, 2010.


Health Care Utilization Following a Fracture: Global Longitudinal Study of Osteoporosis in Women (GLOW).

Ioannidis3,  George, Adachi2,  Jonathan D., Pickard3,  Laura, Chapurlat4,  Roland, Saag5,  Kenneth G., Silverman1,  Stuart L., Flahive6,  Julie

Cedars-Sinai Medical Center, University of California Los Angeles, Beverly Hills, CA
McMaster University, Hamilton, ON, Canada
McMaster University
Universite de Lyon
University of Alabama-Birmingham, Birmingham, AL
University of Massachusetts

Background:

The consequences of fractures are dramatic, including reduced quality of life, and increased mortality and health care costs. Given the high prevalence and negative consequences of fragility fractures resulting from osteoporosis, it is important that health care services are used efficiently to reduce the burden of fracture. However, there is a lack of data regarding the relationship among various fracture types and health care service utilization. The purpose of the study was to determine the health care utilization in women with various fracture types.

Method:

The Global Longitudinal Study of Osteoporosis in Women (GLOW) is an observational, prospective study of women 55 years of age and older who were recruited from 723 primary physician practices across 10 countries (17 sites, 60 393 patients). Women were eligible to participate in GLOW if they were non-institutionalized and if they visited their practice within the past 2 years. Self-administered questionnaires were mailed (2:1 over-sampling of women >=65) at baseline and at 12 months to all eligible patients. The current study was designed to determine the health care utilization among various fracture types using items from both the baseline and year 1 follow-up surveys. New fractures were divided into 4 categories (spine/neck, hip, wrist/hand, and upper arm/shoulder) and occurred during the first year of the study. Health care utilization included where the fracture was treated (doctor's office/clinic, hospital, rehabilitation centre or nursing home), if surgery was performed (yes/no), and the patient's length of stay (days) at the treatment facility.

Results:

A total of 120, 115, 358 and 158 new fractures occurred at the spine, hip, wrist and upper arm, respectively. The mean age (SD) and number of prior fractures (%) were 72.7 (9.1 yr) and 64 (54.2%) for spine, 75.7 (9.0 yr) and 56 (50.0%) for hip, 69.6 (8.9 yr) and 138 (38.9%) for wrist, and 72.1 (9.2 yr) and 60 (39.2%) for upper arm fracture participants. The table displays healthcare utilization for participants with fractures at 1 year.

Healthcare utilizationSpine n = 120Hip n = 115Wrist n = 358Upper arm n = 158
Fracture treated: n (%)
  Office/clinic83 (74.1)62 (57.9)245 (71.4)104 (70.3)
  Hospital61 (55.5)107 (96.4)275 (79.7)127 (84.1)
  Rehabilitation center13 (11.7)66 (60.0)55 (16.8)43 (29.9)
  Nursing home3 (2.8)17 (16.5)3 (0.9)7 (4.9)
Length of stay (days): mean (SD)
  Hospital12 (13)11 (12)6 (12)9 (13)
  Rehabilitation centre17 (18)19 (19)10 (19)22 (29)
  Nursing home5 (8)28 (25)58 (42)18 (3)
Preformed surgery: n (%)16 (26.7)94 (87.9)97 (36.9)41 (34.5)

Conclusions:

In a large practice-based international cohort study, results reveal a wide range in the use of healthcare resources depending of the fracture type, and included where the fracture was treated, the length of stay at the treatment facility, and whether surgery was performed to treat the fracture. However, treatment strategies across countries may, in part, explain the variation in resource utilization observed among fracture types. These data may aid researchers and decision makers in determining policies that will optimize health care service utilization and improve patient outcomes.

To cite this abstract, please use the following information:
Ioannidis, George, Adachi, Jonathan D., Pickard, Laura, Chapurlat, Roland, Saag, Kenneth G., Silverman, Stuart L., et al; Health Care Utilization Following a Fracture: Global Longitudinal Study of Osteoporosis in Women (GLOW). [abstract]. Arthritis Rheum 2010;62 Suppl 10 :969
DOI: 10.1002/art.28736

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