Health burden and costs of osteopenia and osteoporosis attributable hip fractures in Germany in the years 2002, 2020 and 2050

Presenter: Alexander Konnopka, University of Leipzig

Abstract

Aims: Osteopenia and osteoporosis are reductions in bone density which increase with increasing age and cause a high number of fractures at several locations, e.g. hip, wrist and vertebras. The aim of this study was to estimate the health impact and the direct as well as indirect costs of osteopenia and osteoporosis attributable hip fractures (OHF) in Germany in the year 2002 and to extrapolate these estimates to the years 2020 and 2050.
Methods: We estimated deaths, years of potential life lost (YPLL), quality adjusted life years lost (QALYs) and costs due to OHF using the concept of attributable fractions and routine statistics. Direct costs were estimated for acute treatment, rehabilitation, nursing care and nonmedical costs. Indirect costs were estimated for sickness absence, early retirement and mortality. Indirect costs were calculated for paid as well as unpaid work using the human capital approach and discounting future indirect costs by 5% each year. All estimates were extrapolated to the years 2020 and 2050 based on the assumption of constant age dependent prevalence rates of osteopenia and osteoporosis and an estimation of future population composition and life expectancy. Uncertainty was assessed by sensitivity analyses.
Results: We found 108,341 cases of OHF in 2002 of which 85% were in persons older than 70 years and 78% were in women. The OHF cases resulted in 3,485 deaths, 22,724 YPLL, 114,058 lost QALYs and 2,736 million Euro of direct cost as well as 262 million Euro of indirect costs. The majority of direct costs (80%) occurred among women and was mainly due to nursing care (58%) followed by acute hospital stays (27%). Regarding direct costs from nursing care, one must note that 91% of these costs were future nursing care costs resulting from permanent nursing care needs. Indirect costs were mainly due to unpaid work (76%) as a result of OHF occurring predominantly in higher age groups.
Projection to 2020 showed increases in OHF cases, deaths, YPLL, lost QALYs, direct and indirect costs of 44%, 62%, 56%, 49%, 47% and 33%, whereas projection to 2050 resulted in changes of 128%, 215%, 196%, 152%, 138% and 80% respectively. Here we found relatively small increases or even decreases in indirect costs resulting from a decreasing number of persons in working age due to demographic changes. Furthermore, we generally found relatively large increases in men, resulting from a reduced number of men older than 75 years in 2002 as a result of the second world war.
Conclusions: Osteopenia and osteoporosis attributable hip fractures have considerable impact on health and cause high direct costs in elderly. Both may strongly increase in future decades due to the expected demographic changes, calling for improvement and further development of effective strategies for preventing and dealing with OHF.