Breaking the bank: The Costly Global Impact of Osteoporosis Fractures.
Osteoporosis is more than a clinical problem- it’s an economic disaster waiting to happen. Discover how fractures are racking billions globally and why the ‘silent epidemic’ drains health budgets. The numbers are staggering!
Johnell O, Kanis JA. An estimate of the worldwide prevalence and disability associated with osteoporotic fractures. Osteoporos Int. 2006;17(12):1726-1733. doi:10.1007/s00198-006-0172-4.
Cracking Under Pressure
Fragility fractures are not only causing broken bones worldwide but are also breaking health systems worldwide. It is a significant economic burden that is quietly bankrupting global healthcare systems. This past week, I was on call at our local hospital. I had the opportunity to be involved in the care of multiple patients with fragility fractures. Seeing how these fragility fractures affect patients firsthand gives an honest appreciation of what we in the osteoporosis community are dealing with. The burden to the patient and the patient’s family is easy to see. The drastic change in the patient’s way of life is apparent. New challenges with mobility, activities of daily living, and remaining independent are quickly realized by all involved. I started to expand my thinking from the human cost to the financial cost to our institution and the health system. Medicare reimbursement continues to decrease year after year. These fracture patients tend to need more care due to their advanced age. As the population ages here domestically, these costs will continue to increase. This month, in conjunction with World Osteoporosis Day, I am reviewing an article, “An estimate of the worldwide prevalence and disability associated with osteoporotic fractures,” by Johnell and Kanis. This article looks at the worldwide burden of osteoporotic fractures and some possible changes we can make as a community to hopefully reduce the impact these fractures cause. The points below are the key takeaways I found thought-provoking.
The Cost of Fragility: The Numbers
Johnell1 discusses the drastic numbers of 1.6 million hip fractures, 1.4 million vertebral fractures, and 1.7 million forearm fractures that happen yearly. These numbers for any condition are overwhelming to think about. Commonly, these vertebral and hip fracture patients are undergoing some temporizing treatment, whether that is surgical or some functional bracing. They often require hospital stays and potentially discharge to a nursing facility. The cost rapidly increases in all these situations. When looking at that financial cost, we see differences regionally. Europe’s annual cost with fragility fracture patients is 31.7 billion euros annually. In the United States, the estimated cost is 17 billion dollars. Asia also expects an increase in the cost of fragility fractures to the system. These costs are disproportionately higher in developed countries. However, the increased burden will be seen in Asian countries as their population ages.
Hidden Costs
The costs are going to be multifaceted. The direct costs of surgery, rehabilitation, and long-term care are commonly discussed with the burden. As stated above, the costs associated directly with the surgery are billions of dollars. Twenty percent of hip fracture patients end up in a long-term facility.1 These patients can sustain a loss of independence and may require long bouts of formal physical therapy.
The indirect costs of lost productivity in patients still working and caregiver burden are more challenging to see plainly. Health systems will also feel these impacts. Fragility fractures strain the fragile state of medicine. Available rooms within hospitals and long-term care facilities can be limited. These fractures will only increase that burden. The increased psychological costs also get missed. Fracture patients can experience instances of depression or anxiety due to the immense change in their lives in a short period.
These combined direct and indirect costs continue to compound on the overall national and international healthcare systems.
Gaps in care
We continue to need more overall tactics for detecting and preventing the disease. Osteoporosis remains underdiagnosed in most patients. Patients should not have to sustain a fracture to be diagnosed with osteoporosis. The need for more proactive screening is apparent. Once these patients are identified, the use of medications to treat osteoporosis is also underwhelming. Johnell notes there are regional differences in the incidence of fragility fractures.1 More fragility fractures are identified in highly developed countries like Europe and North America than in Africa and Asia.1 This is likely due to less developed countries having higher barriers to diagnosis and treatment of osteoporosis.
Prioritizing prevention over treatment would have a significant and real-world impact. Hip fractures are a substantial burden on the healthcare system. They can account for 6-70% of the overall fracture burden due to the expenses accrued during surgery and perioperatively.1 Additionally, those who undergo surgery frequently have osteoporosis. Receiving medication for these osteoporotic fractures is also sub-optimal in a state where many pharmaceutical options are present.
Johnell1 notes that global data is limited but growing. Aggregating this data can help us better understand the care gaps associated with osteoporosis. This will allow the formation of unique solutions to improve patient outcomes. Therefore, investment in these global data platforms is a must in the future.
Johnell and Kanis present critical facts about the worldwide burden of this disease. This article was published in 2006. Unfortunately, many of these problems still exist in 2024. What can we do to change that? How can we make this better? As we think about this on World Osteoporosis Day, we should look into the future and ask how to improve. What actions can we take individually as healthcare professionals to close these gaps?
