Incidence And Risk Factors Of Medical Complications And Economic Burden Of Osteoporotic Fracture Patients

Objectives: To investigate the incidence and identify the risk factors of complications after osteoporotic fracture,estimate patients' healthcare resource utilization and direct medical costs,and the impact of complications on patients' healthcare resource utilization and direct medical costs.Methods: Data were obtained from Tianjin Urban Employee Basic Medical Insurance database(2009–2014).Patients aged ?50 years who had ?1 diagnoses of any osteoporotic fracture between 2010.1.1 and 2012.12.31,and were continuously enrolled from 12 months before(baseline)to 24 months after(follow-up)the first identified osteoporotic fracture were included.The incidence of medical complications and surgical complications after any osteoporotic fracture were estimated,and the incidence of medical complications was compared during the 12 months before and after fracture using Mc Nemar's chi2.Osteoporosis-related and all-cause healthcare resource utilization and direct medical costs were measured during the 12-and 24-month follow-up periods,and subgroup analysis was conducted for healthcare resource utilization and direct medical costs between patients with and without any complication.Logistic regression model was used to identify the risk factors for complications,while multivariable linear regression model was applied to identify the factors of complications of patients' hospitialization length and the factors of patients' direct medical costs.Results: A total of 7,984 patients were identified(mean age,65.4±10.3years;61.2% female;C harlson Comorbidity Index,1.21 ± 1.50).The most common fractures were vertebral fracture,hip fracture and arm fracture.For total osteoporotic fracture patients,the post-fracture incidence of complications such as constipation,stroke,urinary tract infection,pneumonia,arrhythmia,angina,electrolyte imbalancewas significantly higher than that before fracture(all p<0.001).Patients aged older,with “retired” working statues were more likely to have complications.Compared to those with arm fracture in index date,patients with verterbral fracture,hip fracture or multiple sites fracture were more likely to have complications.And then the comorbidities,such as hypertension,chronic heart diseases,cerebrovascular disease,chronic pulmonary disease,peripheral vascular disease or hemiplegia,hospitalization history and higher baseline all-cause direct medical cost also were the risk factors of complications.The accumulated osteoporosis-related direct medical costs of total fracture samples during the 12-month follow-up period was ?11,555±20,039,while the osteoporosis-related direct medical costs spent in the first 12-month accounted for 93%;and the accumulated direct medical costs during the 24-month follow-up period was ?28,632±35,411.The subgroup analysis indicated that the percentage of inpatients among patients with any complication was higher than that of patients without any complication.The all-cause direct medical costs of patients with complications was higher than that of patients without complications,especially hospitalization costs(all p<0.001).Conclusions: Osteoporotic fracture associated with a large amount of medical and surgical complications.The healthcare resource utilization and economic burden of osteoporotic fracture patients is heavy and become larger among patients with complications.Effective intervention for osteoporosis should be made in clinical practice to decrease the incidence of osteoporotic fracture and to prevent complications after osteoporotic fracture.