OBJECTIVES: Osteoporosis may be caused by insulin deficiency or hypercalciuria associated with glycosuria. This study assessed elevated healthcare resource utilization (HCRU) overall and at different tiers of medical services among diabetes mellitus (DM) patients with osteoporosis (DMwOP).

METHODS: A retrospective cohort study using a city-level administrative claims database between 2012-2015 in China. Adults (aged ≥18 years) with evidence of DM (≥1 claim with a diagnosis of DM or for blood-glucose lowering medication) were firstly identified. Within the DM population, those with evidence of osteoporosis (≥1 claim with a diagnosis of osteoporosis or fragile fracture) were identified. Osteoporosis evidence can be either before or after DM evidence. The rest DM patients were defined as DM without osteoporosis (DMw/oOP). Descriptive analyses and comparison tests between DMwOP and DMw/oOP patients were performed in SAS 9.4.

RESULTS : Of the 41,693 DM patients, 62% had osteoporosis. DM patients with osteoporosis was significantly older (mean age 62.0 vs. 57.9, P<0.001). The number of outpatient visits per person per year (PPPY) among DMwOP almost doubled that among DMw/oOP (46 vs. 25 times, p<0.001). Outpatient cost PPPY was also significantly higher among DMwOP (USD 1,496.32 vs USD 859.09, p<0.001). Over half of outpatient visits were at primary and secondary hospitals and community clinics (58% vs. 51% among DM patients with vs. without osteoporosis). The number of hospitalization, length of stay PPPY and costs of hospitalization were similar among DMwOP and DMw/oOP.

CONCLUSIONS: Given the very high prevalence of osteoporosis in DM patients as well as elevated outpatient visits and costs among DMwOP, targeted screening, diagnosis and treatment of osteoporosis should be promoted in the increasing DM population. The important role of primary and secondary hospitals and community clinics in the service provision to DMwOP also highlight the urgency of increasing the capability of low-tier health care services.