Epidemiology and economic burden of fragility fractures in Austria

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Abstract

Summary

Fragility fractures are a frequent and costly event. In Austria, 92,835 fragility fractures occurred in patients aged ≥ 50 years in 2018, accruing direct costs of > 157 million €. Due to demographic aging, the number of fragility fractures and their associated costs are expected to increase even further.

Introduction

Fragility fractures are frequently associated with long hospital stays, loss of independence, and increased need for care in the elderly, with consequences often leading to premature death. The aim of this study was to estimate the number of fragility fractures and associated healthcare costs in Austria in 2018.

Methods

The number of in-patient cases with relevant ICD-10 diagnoses in all Austrian public hospitals was derived from discharge documentation of diagnoses and procedures covering all public hospitals in Austria. Fractures resulting from falls from standing height in patients aged ≥ 50 years were used as a proxy for fragility fractures, and the number of in-patient and out-patient cases was estimated. The direct costs of these cases were calculated using the average cost of the corresponding in-patient hospital stay and the average cost for the out-patient stay.

Results

The present study estimated the number of fragility fractures (pelvis, thoracic and lumbar vertebra, hip, humerus, rib, forearm, and tibia) for 2018 at 92,835 or just over half of all fractures in patients aged ≥ 50 years, corresponding to a prevalence of 2,600 per 100,000 inhabitants of this age group. A constant increase in the proportion of fragility fractures among all fractures was observed with increasing age in both men and women. These fractures amounted to direct costs of > 157 million €.

Conclusion

Fragility fractures are a frequent and costly event in Austria. Due to the aging of the population, the number of fragility fractures and their associated costs is expected to increase even further.

Supplementary Information

The online version contains supplementary material available at 10.1007/s00198-021-06152-6.

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Most cited references 27

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A systematic review of hip fracture incidence and probability of fracture worldwide

J Kanis, Thomas A. Odén, E. McCloskey … (2012)

Summary The country-specific risk of hip fracture and the 10-year probability of a major osteoporotic fracture were determined on a worldwide basis from a systematic review of literature. There was a greater than 10-fold variation in hip fracture risk and fracture probability between countries. Introduction The present study aimed to update the available information base available on the heterogeneity in the risk of hip fracture on a worldwide basis. An additional aim was to document variations in major fracture probability as determined from the available FRAX models. Methods Studies on hip fracture risk were identified from 1950 to November 2011 by a Medline OVID search. Evaluable studies in each country were reviewed for quality and representativeness and a study (studies) chosen to represent that country. Age-specific incidence rates were age-standardised to the world population in 2010 in men, women and both sexes combined. The 10-year probability of a major osteoporotic fracture for a specific clinical scenario was computed in those countries for which a FRAX model was available. Results Following quality evaluation, age-standardised rates of hip fracture were available for 63 countries and 45 FRAX models available in 40 countries to determine fracture probability. There was a greater than 10-fold variation in hip fracture risk and fracture probability between countries. Conclusions Worldwide, there are marked variations in hip fracture rates and in the 10-year probability of major osteoporotic fractures. The variation is sufficiently large that these cannot be explained by the often multiple sources of error in the ascertainment of cases or the catchment population. Understanding the reasons for this heterogeneity may lead to global strategies for the prevention of fractures.

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Epidemiology of osteoporotic fractures.

Olof Johnell, John Kanis (2005)

Several osteoporotic fractures such as hip fractures have a very high morbidity and mortality, and there are similar new findings for vertebral fractures. There have been several definitions of an osteoporotic fracture, and recently updated definitions have specified fractures occurring at a site associated with low BMD and which increase in incidence after the age of 50 years. Other definitions are based on clinical diagnosis. Lifetime risk of any osteoporotic fracture is very high and lies within the range of 40-50% in women and 13-22% for men. Measuring the true burden of osteoporotic fractures involves multiplying the morbidity of hip fractures according to age group: for women aged 50-54 years, the disability caused by osteoporotic fractures is 6.07 times that accounted for by hip fracture alone, and for women aged 80-84 years, the incidence of hip fractures should be multiplied by 1.55; for men aged 50-54 years, the incidence of hip fractures should be multiplied by 4.48, and for those aged 80-84 years by 1.50.

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Bone mineral density thresholds for pharmacological intervention to prevent fractures.

Robert T. Abbott, Kevin Berger, Elizabeth Barrett … (2004)

Treatment intervention thresholds for prevention of osteoporotic fractures can be derived from reports from the World Health Organization (diagnostic criteria) and National Osteoporosis Foundation (treatment criteria). It is not known how well these thresholds work to identify women who will fracture and are therefore candidates for treatment interventions. We used data from the National Osteoporosis Risk Assessment (NORA) to examine the effect of different treatment thresholds on fracture incidence and numbers of women with fractures within the year following bone mineral density measurement. The study comprised 149 524 white postmenopausal women aged 50 to 104 years (mean age, 64.5 years). At baseline, bone mineral density was assessed by peripheral bone densitometry at the heel, finger, or forearm. New fractures during the next 12 months were self-reported. New fractures were reported by 2259 women, including 393 hip fractures; only 6.4% had baseline T scores of -2.5 or less (World Health Organization definition for osteoporosis). Although fracture rates were highest in these women, they experienced only 18% of the osteoporotic fractures and 26% of the hip fractures. By National Osteoporosis Foundation treatment guidelines, 22.6% of the women had T scores of 2.0 or less, or -1.5 or less with 1 or more clinical risk factors. Fracture rates were lower, but 45% of osteoporotic fractures and 53% of hip fractures occurred in these women. Using peripheral measurement devices, 82% of postmenopausal women with fractures had T scores better than -2.5. A strategy to reduce overall fracture incidence will likely require lifestyle changes and a targeted effort to identify and develop treatment protocols for women with less severe low bone mass who are nonetheless at increased risk for future fractures.

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Author and article information

Contributors

J. Grillari:

ORCID: http://orcid.org/0000-0001-5474-6332

johannes.grillari@trauma.lbg.ac.at

Journal

Journal ID (nlm-ta): Osteoporos Int

Journal ID (iso-abbrev): Osteoporos Int

Title: Osteoporosis International

Publisher: Springer London (London )

ISSN (Print): 0937-941X

ISSN (Electronic): 1433-2965

Publication date (Electronic): 8 October 2021

Publication date PMC-release: 8 October 2021

Pages: 1-11

Affiliations

[1 ]GRID grid.488364.5, Medical Department II-VINFORCE, , St. Vincent Hospital, ; Vienna, Austria

[2 ]The Austrian National Public Health Institute, Vienna, Austria

[3 ]GRID grid.420022.6, ISNI 0000 0001 0723 5126, Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, , AUVA Research Center, ; Donaueschingenstraße 13, A-1200 Vienna, Austria

[4 ]GRID grid.5173.0, ISNI 0000 0001 2298 5320, Institute for Molecular Biotechnology, , BOKU – University of Natural Resources and Life Sciences, ; Vienna, Austria

[5 ]GRID grid.511951.8, Austrian Cluster for Tissue Regeneration, ; Vienna, Austria

[6 ]Hemetsberger Medical Services, Vienna, Austria

[7 ]GRID grid.11598.34, ISNI 0000 0000 8988 2476, Division of Endocrinology and Diabetology, Department of Internal Medicine, , Medical University of Graz, ; Graz, Austria

Author information

C. Muschitz http://orcid.org/0000-0002-4105-5361

M. Hummer http://orcid.org/0000-0001-7487-9773

J. Grillari http://orcid.org/0000-0001-5474-6332

M. Hemetsberger http://orcid.org/0000-0003-1877-6838

H. P. Dimai http://orcid.org/0000-0001-8155-8265

Article

Publisher ID: 6152

DOI: 10.1007/s00198-021-06152-6

PMC ID: 8497183

PubMed ID: 34622302

SO-VID: 99b02660-62cf-48d4-bdf2-b1f8690a1ed3

License:

Open AccessThis article is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License, which permits any non-commercial use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc/4.0/.

History

Date received : 25 May 2021

Date accepted : 7 September 2021

Funding

Funded by: Amgen GmbH (AT)

Funded by: University of Natural Resources and Life Sciences Vienna (BOKU)

Open Access :

Open access funding provided by University of Natural Resources and Life Sciences Vienna (BOKU).

Epidemiology and economic burden of fragility fractures in Austria

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Abstract

Summary

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Conclusion

Supplementary Information

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Orthopedics

Most cited references 27

A systematic review of hip fracture incidence and probability of fracture worldwide

Epidemiology of osteoporotic fractures.

Bone mineral density thresholds for pharmacological intervention to prevent fractures.

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