OBJECTIVES: To quantify subsequent fractures, resource use and costs following an initial osteoporosis-related fracture (ORF) in France.

METHODS: This retrospective cohort study used the SNDS (Système National des Données de Santé) claims database covering approximately 65 million insurees in France. Men and women >50 years, with a hospital discharge diagnosis of osteoporosis with fracture or an ORF at the hip, vertebrae, or other site (radius/ulna, wrist/hand, humerus/clavicle, pelvis or femur) between 2011 and 2014 were included and followed-up until the end of 2016. Index event was the first qualifying hospitalization; subsequent fractures were defined as those occurring either at a different site from index fracture or at the same site ≥90 days apart. Costs including treatment, hospitalization and external consultation were abstracted.

RESULTS: A total of 574,133 patients (138,567 (24%) men, 435,566 (76%) women, mean age: 78 years) were included (median [IQR] follow-up of 3.1 [2.1, 4.4] years). Of these, 6.1% had an osteoporosis diagnosis at index date. During follow-up, 51,074 (36.9%) men and 120,572 (27.7%) women died, of whom 49.5% and 38.1%, respectively, died within the first year. 121,759 subsequent fractures occurred at the hip (n=49,162), vertebrae (n=9,969), or other site (n=62,628). Among patients with ≥1 subsequent fracture, 98,814 subjects (89.8%) had >1 hospital stay (median [IQR] duration 10 [7, 15] days). Median [IQR] total osteoporosis-related costs per patient in the year following the index event was higher for men (€5,416 [€2,007, €8.844]) versus women (€4,172 [€1,534, €7,546]), those with (€5,773 [€1,928, €9,657]) versus without (€4,172.2 [€1,686, €7,864]) subsequent fracture and for hip (€7,235 [€6,123, €10,017]) versus vertebral (€3,084 [€1,133, €6,143]) or other site (€2,186[€986, €4,541]) fractures.

CONCLUSIONS: The clinical and cost burden following an initial ORF is high. Timely treatment may lower the incidence of recurrent fractures, and reduce the morbidity, mortality and resource use/costs among these patients.