OBJECTIVES: Osteoporotic fractures are associated with pain, disability, and mortality, with corresponding healthcare implications. The study objectives were to describe the incidence and real-world costs associated with the management of primary fragility fractures in patients over 65 years of age in Ontario, Canada.

METHODS: Institute for Clinical Evaluative Sciences datasets were used to identify patients with a primary fragility fracture based on ICD-diagnostic codes for hospital admissions, emergency, and ambulatory care. Patients were included in the study cohort if they had a primary event between January 1, 2011 and March 31, 2015, and were followed through subsequent years (up to a maximum date of March 31, 2017). Costs were expressed in 2017 CAD.

RESULTS: The total number of primary fragility fractures was 25,154 in 2011 and increased to 28,892 in 2015, representing a 5-year average incidence rate of 15.7 per 1,000 persons over the age of 65. Mean age at primary event was 80.4. Mean annual healthcare costs per patient one year post-primary event were $39,089 (SD $43,272). Hip was the most common fracture site (27%) while femur fracture was the most costly to manage ($66,166/patient/year).

Hospitalizations and care services (continuing, home, and long-term) comprised the largest cost categories in the first year post-primary event (37% and 31%, respectively), while prescription drug costs were the smallest (5%). While costs decreased over time, mean costs up to five years post-primary event remained high (>$10,000/patient). Costs increased with patient age and number of comorbidities.

CONCLUSIONS: Fragility fractures incur a substantial economic burden and the number of fractures is increasing. Total healthcare costs to manage the study cohort in the first year post-primary event were estimated at ~$1B in Ontario. Further research is required to determine appropriate treatment of osteoporotic fracture patients and prevention methods to decrease the burden of fractures on society.