<p>Economic Burden of Osteoporotic Patients with Fracture: Effect of Treatment With or Without Calcium/Vitamin D Supplements</p>

Abstract

Background: Fractures represent the most important complication of osteoporosis, in terms of loss of independency, chronic pain, increased risk of mortality, but also high healthcare costs. Objective: To assess healthcare costs in an Italian cohort of osteoporotic patients with a fracture with and without specific osteoporosis treatment and supplementation with calcium/vitamin D. Methods: This retrospective observational study used data from administrative databases of five Local Health Units in Italy. Patients ≥50 years of age and hospitalized for vertebral or hip fracture occurring from 01/01/2011 to 31/12/2015 were included. Patients were then classified as "untreated" and "treated" if they had been treated or not with drugs for fracture prevention after the index fracture. We also identified subjects that were only treated with drugs for fracture prevention, "osteoporosis drug only" group, compared to the "osteoporosis drug plus calcium/vitamin D" group, in which calcium and/or vitamin D were also in combination. Healthcare cost analysis included drug expenditure, hospitalization costs (excluding costs related to the hospitalization for the index fracture) and outpatient service costs. Results: Three thousand four hundred and seventy-five patients were included in the present study, most of whom (58.5%) had received specific osteoporosis treatment after index fracture. Among treated patients, the vast majority (83.6%) received supplementation with calcium/vitamin D. Mean annual healthcare cost per patient was €9,289.85 in the untreated group and €4,428.26 for treated subjects (p < 0.001); mean annual healthcare cost for the osteoporosis drug-only group was higher compared to the osteoporosis drug plus calcium/ vitamin D group (€5,976.88 vs €4,124.74, respectively, p < 0.001). Hospitalization costs accounted for the majority of total costs in all groups of patients. Conclusion: Healthcare costs in patients with osteoporotic fractures were significantly lower in those receiving osteoporosis treatment compared to untreated patients with even lower costs observed in patients that were also receiving calcium/vitamin D supplements.

The Potential Impact of Inducing a Restriction in Reimbursement Criteria on Vitamin D Supplementation in Osteoporotic Patients with or without Fractures

“…Furthermore, patients with calcium/VD supplement in addition to osteoporosis drug after a fracture were associated with a 64.4% lower risk of developing a subsequent fracture and with a two-fold lower mortality risk compared to the group receiving osteoporosis drugs only. In parallel with findings for clinical outcomes, the presence of calcium/VD supplementation was also found to be associated with lower mean annual healthcare costs, with hospitalization expenditure accounting for 73.7% and 55.2% of the total cost for the osteoporosis drugs only cohort and osteoporosis drug with calcium/VD cohort, respectively [29]. Overall, evidence from literature highlights the importance of ensuring adequate VD supplementation for the prevention of osteoporotic fragility fracture, to decrease the incidence of these events and to limit the associated economic burden.…”

The effect of exercise post vertebral augmentation in osteoporotic patients: A systematic review and meta‐analysis

“…2 VFs, among other osteoporotic fractures, can result in a loss of independence, chronic pain, increased mortality, reduced quality of life, and ultimately increased healthcare costs. 3,4 Depending on each patient circumstance, conservative management may be the initial treatment offered. This may comprise a combined use of bed rest, analgesics, anti-osteoporotic medications, exercise, and various braces.…”

“…Prevalence up to the age of 50 is relatively similar between both sexes, but prevalence in women increases up to fivefold for deformities after the age of 50 2 . VFs, among other osteoporotic fractures, can result in a loss of independence, chronic pain, increased mortality, reduced quality of life, and ultimately increased healthcare costs 3,4 . Depending on each patient circumstance, conservative management may be the initial treatment offered.…”