OBJECTIVES: To describe hospital resource utilisation and costs of index and imminent subsequent fragility fractures (ISF) in postmenopausal women using electronic health records (EHR) from the UK (CPRD_Aurum-HES) and Spain (SIDIAP-CMBD) mapped to the OMOP common data model.

METHODS: A time-stratified propensity-score-matched study identified three cohorts of women aged ≥50 in 2010-2018: ISF within two years of their index fracture (F2); index fracture with no fracture 2-years prior (F1); and without fractures (F0). The impact of index (F1 vs. F0) and subsequent fractures (F2 vs. F1) was described between the matched cohorts. Hospital care comprised emergency, outpatient and inpatient admissions for CPRD-HES and inpatient only for SIDIAP-CMBD, described by median number of admissions per woman per year (PWPY) and length of stay (LoS). Mean costs PWPY were estimated using a bespoke algorithm (CPRD-HES), weighted average unit costs and national tariffs.

RESULTS: Analyses were based on 211,086 and 650,757 women for F1 vs. F0, and 56,427 and 186,924 for F2 vs F1, respectively.

Hospital resource use was higher for F1 compared to matched-F0 in emergency, outpatient, all-cause hospitalisations and LoS. Emergency and outpatient costs were £201 and £336 higher for F1; for fracture-related hospitalisations, they were £289 (CPRD-HES) and €154 (SIDIAP-CMBD) higher for F1.

F2 reported lower resource use than matched-F1 in emergency and outpatient. All-cause hospitalisations were equal in both databases, LoS the same in SIDIAP-CMBD and lower for F2 in CPRD-HES. Emergency and outpatient costs were £62 and £119 lower for F2; £34 lower for fracture-related hospitalisations in CPRD-HES and €26 higher in SIDIAP-CMBD.

CONCLUSIONS: Fragility fractures are associated with a significant hospital care burden, with imminent subsequent fractures adding extra load though slightly less than index fractures. This is the first network study estimating hospital resource utilisation and costs of fractures based on EHR mapped to the OMOP-CDM.