Presentation (CTI)

OBJECTIVES: Fragility fractures, defined as fractures occurring from low-impact falls, represent a significant healthcare challenge in ageing societies. While Europe reports 3.5 million fragility fractures annually, several Asian countries are experiencing rapidly rising rates due to aging populations.
METHODS: We conducted a retrospective database review of fragility fracture encounters across all public healthcare settings in Singapore's central zone (population: 1.01M; 439k ages ≥50 years) during 2023. The study included patients aged ≥50 years with a primary diagnosis of fractures from low-impact falls without a history of trauma or malignancy. Cost analysis incorporated direct and indirect costs from a patient’s perspective. Healthcare utilisation patterns and costs were analysed across primary care, emergency, specialist outpatient, day surgery, and inpatient settings.
RESULTS: We identified 5,666 patients with fragility fractures, showing a period prevalence of 12.90 per 1,000 residents, with higher rates in females (17.16%) compared to males (8.13%). Prevalence increased markedly with age, from 5.20 per 1,000 in ages 50-60 to 34.88 in those >80 years. Healthcare utilisation analysis revealed that 77.3% required specialist outpatient care, 49.9% accessed emergency services and 29.3% required surgical intervention. The mean inpatient stay was 17.7 days. The total direct medical costs of fragility fractures in the central region of Singapore in 2023 amounted to USD 68.7 million. Mean costs per encounter varied from USD 218 in primary care to USD 28,902 for inpatient care.
CONCLUSIONS: Our findings provide a conservative estimate to the economic burden of fragility fractures, patients’ healthcare utilisation patterns and high individual patient cost of care. This data calls for the development of cost-effective, collaborative care models and a preventive multidisciplinary approach in the management of determinants of frailty. This study represents the first population-based study in Singapore to evaluate the economic burden and healthcare utilisation patterns of fragility fractures across all care settings.