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Purpose In osteoporosis, prior fracture is a strong predictor of subsequent fracture. This study aimed to assess the imminent risk of subsequent fracture following an initial fracture in osteoporosis patients in Germany, and to identify clinical and demographic characteristics that are independently associated with subsequent fracture risk. Methods In this retrospective, observational cohort study using German real-world claims data, male and female patients aged ≥ 50 years with osteoporosis who experienced an initial (“index”) hip/femur, vertebral, forearm/wrist/hand or shoulder/upper arm fracture between 2010 and 2014 were included. The incidence and timing of subsequent fractures during a 1-year follow-up period were analyzed. Independent risk factors for subsequent fracture were identified by multivariate regression analysis. Results A total of 18,354 patients (mean age: 77 years; standard deviation: 9.8) were included. Of these, 2918 (15.9%) suffered a subsequent fracture during the 1-year follow-up period. The incidence of subsequent fracture was higher following an index vertebral fracture (18.0%) than after an index forearm/wrist/hand fracture (14.1%) or index hip/femur fracture (12.1%). Subsequent 1-year fracture incidence was generally higher in older patients. Index fracture type, age, epilepsy/use of antiepileptics, and heart failure were all independently associated with subsequent fracture risk. Conclusion Osteoporosis patients in Germany are at imminent risk of subsequent fracture during the first year following an initial fracture. They should be targeted for immediate post-fracture treatment to reduce the risk of further fractures, especially in the presence of specific risk factors such as old age or index vertebral fracture.

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Status epilepticus (SE) is a life-threatening emergency and to date, few studies have reported on its long-term treatment and outcomes. This study aimed to estimate the incidence, the treatment and outcomes, the healthcare resource utilization and the costs of SE in Germany. Data from 2015 to 2019 were obtained from German claims (AOK PLUS) Patients with ≥1 SE event and no event in the preceding 12 months (baseline) were included. A subgroup of patients with epilepsy diagnosis during baseline was also analyzed. Of the 2,782 SE patients (mean age=64.3 years; 52.3% female), 1,585 (57.0%) were previously diagnosed with epilepsy. The age- and sex standardized incidence was 25.5 cases/100,000 persons in 2019. Mortality rate after 12 months was 39.8% overall (19.4% and 28.2% after 30 and 90 days respectively), and 30.4% in the epilepsy patient subgroup. Factors associated with higher mortality were age, comorbidity status, presence of brain tumors and an acute stroke. An epilepsy-related hospitalization at onset of or 7 days prior to the SE event as well as prescription of antiseizure medication (ASM) during baseline were associated with a better survival rate. Overall, 71.6% of patients (85.6% in epilepsy subgroup) were prescribed with outpatient ASM and/or rescue medication within 12 months. All patients sustained on average 1.3 SE-related hospitalizations (20.5% had >1) during a mean follow-up period of 545.2 days (median 514 days); total direct costs including inpatient and outpatient SE-treatment were 10,826€ and 7,701€ per patient-year overall and for epilepsy patient subgroup respectively. The majority of SE patients received an outpatient treatment in line with epilepsy guidelines, patients previously diagnosed with epilepsy have a higher likelihood to receive it. The mortality in the affected patient population is high; risk factors were older age, higher comorbidity burden, the presence of brain tumors or an acute stroke.