Burden of accumulating fragility fractures on health service usage and costs among post-menopausal women.

Cumulative fragility fractures markedly raise mortality, care needs, and healthcare costs among post-menopausal women. Women with ≥3 fractures show 2.2 times higher mortality rate and 1.4 times higher costs. These findings suggest that effective fracture prevention strategies may help reduce healthcare costs and alleviate some of the rising societal burden as populations age. PURPOSE: This study aimed to evaluate the cumulative burden of fragility fractures on health service usage and costs among post-menopausal women over a long follow-up period.

methodsPooled data from the Kuopio Osteoporosis Risk Factor and Prevention Study (OSTPRE) and Kuopio Fall Prevention Study (KFPS), yielding a population-based cohort of 16,726 Finnish women born between 1932 and 1945, were used. Fracture data were collected from self-reports, national registers, and radiologic visits, and health service utilization and costs were assessed through unit costs calculated using the linked healthcare and social welfare registers. Outcomes included mortality, admissions to long-term care, inpatient care days, and healthcare costs. Follow-up spanned a median of 33.7 years and over 533,570 person-years. Generalized linear mixed models were used for statistical analysis.

resultsCumulative fractures were strongly associated with increased mortality, inpatient care days, transitions to long-term care, and higher healthcare costs. Women with three or more fractures had more than twice (IRR 2.2, 95% CI 2.0-2.4) the mortality rate and 1.4 (95% CI 1.3-1.5) times higher annual healthcare costs compared to women without fractures. A clear gradient in all outcome categories was observed across increasing numbers of fractures.

conclusionAn increasing number of fragility fractures is associated with the elevated societal costs and the burden on healthcare services even after adjustment for age, comorbidities, education level, and BMI. As populations age, the growing prevalence of fragility fractures will substantially strain health systems unless preventive measures are implemented. Secondary prevention of fractures may help to mitigate future care needs and costs.