Risk And Burden Of Subsequent Fractures After First Osteoporosis-related Fracture Among Osteoporosis Patients

Objectives:To explore the incidence and risk factors of subsequent fractures after an osteoporosis-related fracture for providing an objective basis to predict subsequent fractures,and to decrease the burden of health care resource utilization(HRU)and direct medical costs in Tianjin,China.And to assess the time intervals between consecutive fractures for providing time windows to take preventive interventions.Methods: Data were obtained from 30% of the randomized sample population of Tianjin Urban Employee Basic Medical Insurance database(2008-2013).Patients who were?50 years old,had ?1 diagnoses of osteoporosis-related fracture between2009 and 2011,and 12-month continuous enrollment before(baseline)and 24-month after(follow-up)first certain fracture diagnosis were identified.Incidence of subsequent fractures and time intervals between consecutive fractures were calculated.All-cause and osteoporosis-related HRU and direct medical costs were assessed.Comparisons between patients with and without subsequent fractures were conducted using t-tests and chi-square tests.Logistic regression was used to evaluate the risk factors of subsequent fractures.Results:(1)A total of 8,478 patients were identified,with mean age of 65.3(±10.3)years,62.0% female and 14.5%(N=1,229)of them having subsequent fracture.(2)Among those patients,19.5%(N=240)experienced a third fracture;among them,25.0%(N=60)experienced a fourth one;and 46.7%(N=28)of them experienced a fifth fracture.Mean(SD)time intervals were 236.8(±227.8)days between the first and second fractures,178.3(±190.2)days between the second and third fractures,110.2(±134.2)days between the third and fourth one,and 99.8(±131.8)days between the fourth and fifth fractures.(3)For osteoporosis-related health services,patients with subsequent fractures had more times of hospitalization(2.2 vs.1.1,p<0.001),longer mean length of hospitalization stay(36.6d vs.18.8d,p<0.001),and more frequency of outpatient visits(12.0 vs.8.6,p<0.001)than those without subsequent fractures.(4)Subsequent fracture cohort incurred significantly higher osteoporosis-related and all-cause costs than those without subsequent fracture cohort(?46,167 vs.?22,365 and ?27,806 vs.?6,991,respectively)(both p<0.001).(5)The logistic regression model revealed that female,retired,poor health status indicated by Quan-Charlson Comobidity Index(CCI),surgery due to first fracture,and first fracture happening in hip,vertebral,clavicle and lower limb were associated with a higher risk of subsequent fractures.Conclusions: There is a high risk of re-fracture during the first year after the first fracture,as the number of fractures increases,the risk of subsequent fractures increases numerically and the mean interval between fractures becomes numerically shorter.Subsequent fractures increase the length of hospitalization stay,numbers of outpatient visits and direct medical costs,clinicians should prevent subsequent fractures among patients whose first fracture occurs in the clavicle,lower limb,or hip,it will decrease the HRU and direct medical costs.