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.

Assessment of the Incremental Cost of Osteoporosis-Related Fractures among Women in a Large U.S. Managed Care Population.

Viswanathan1,  Hema, White6,  Jeffrey, Wade5,  Sally W., Yu3,  Jingbo, Curtis4,  Jeffrey R., Stolshek2,  Bradley, Merinar2,  Claire

Amgen Inc., Thousand Oaks, CA
Amgen Inc.
HealthCore, Inc.
University of Alabama - Brimingham, Birmingham, AL
Wade Outcomes Research and Consulting
WellPoint, Inc.


While incremental or attributable costs of osteoporosis (OP)-related fractures have been reported, data on the economic impact of OP-related fractures in commercial health plan populations are limited. The objective of this study was to quantify the incremental cost of OP-related fractures among women in a large U.S. managed care plan between 2004 and 2008.


Female patients were identified from a large, commercially-insured population with integrated pharmacy and medical claims. Patients were included if they were age 45 to 64 years, had an OP medication claim between 1/1/2005 and 4/30/2008 (first claim defines index date), and had continuous coverage for 12 months pre-index. Patients were excluded if they had: pre-index Paget's disease or malignant neoplasm, were in a skilled nursing facility, on combination therapy at index, or had a fracture <= 6 months post-index. Clinically-diagnosed and coded fractures were identified using published claims criteria; total direct costs were assessed in the 6 months pre- and post-fracture event date. Event dates were assigned to patients with no fracture; propensity score weighting was used to increase comparability of fracture and non-fracture patients. A generalized linear model was used to compare differences in 6 months pre-/post-event cost for patients with fracture and those without fracture. Covariates included demographics, prior fractures, comorbidities, and other potential confounders. Generalized estimating equations methods were used to account for repeated measures.


The study population included 47,650 women (N = 2,461 with fracture) with a mean (± SD) age of 56.4 ± 4.7 years. Mean unadjusted total costs showed minor variation in the 6 months pre-event vs post-event for non-fracture patients. Mean pre-/post-event cost differences were substantially larger for patients with vertebral, hip, or other fractures (Table).

Table. Unadjusted Mean Total Direct Costs Per Patient

 Mean Total Direct Costs Per Patient (95% Confidence Interval) for Patients With:
 Vertebral FractureHip FractureOther FractureNo Fracture
Number of Patients2141382,10945,189
6 Months Pre-Event$12,888 ($8,381, $17,395)$7,766 ($5,542, $9,989)$5,195 ($4,751, $5,640)$3,207 ($3,136, $3,278)
6 Months Post-Event$27,303 ($21,088, $33,517)$23,935 ($19,133, $28,737)$12,218 ($11,185, $13,250)$3,226 ($3,159, $3,292)
Post-Event Minus Pre-Event (Difference)$14,415 ($7,559 $21,271)$16,169 ($11,484, $20,855)$7,023 ($6,011, $8,034)$19 ($56, $94)

After adjusting for covariates, OP-related fractures were associated with an estimated $9,512 (95% CI: $8,364, $10,660, p < 0.0001) per patient in additional direct health care costs across all fracture types during the 6 months immediately after the fracture.


On average, women with an OP-related fracture incurred nearly $10,000 in additional health care costs in the 6 months post-fracture compared with patients with no fracture. Efforts to reduce fracture risk may ultimately lower associated direct health care costs.

To cite this abstract, please use the following information:
Viswanathan, Hema, White, Jeffrey, Wade, Sally W., Yu, Jingbo, Curtis, Jeffrey R., Stolshek, Bradley, et al; Assessment of the Incremental Cost of Osteoporosis-Related Fractures among Women in a Large U.S. Managed Care Population. [abstract]. Arthritis Rheum 2010;62 Suppl 10 :1540
DOI: 10.1002/art.29306

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