OBJECTIVES: To estimate the direct economic burden of osteoporotic fracture (OF) in women aged >50 years in Australia, Germany, South Korea, Spain and the US using a standardized methodology.

METHODS: Retrospective cohort study was conducted. The index date was the date of the first OF (hip, vertebral, pelvis, tibia/fibula, radius/ulna, humerus, ribs, clavicle, and scapula) occurred between 1/2013 and 11/2018 in Australia, Germany, Spain, and South Korea or between 1/2015 and 11/2020 in the US. Each eligible patient was required to have data available for ≥18 months prior to and ≥30 days post the index date, with no fracture during the pre-index period. Identified OF patients were matched 1:3 to fracture-free controls within 6-month periods using propensity scores based on important baseline characteristics (eg, age, geography, race/ethnicity, pre-index medication use, Charlson comorbidity index, and key comorbidities). Generalized linear mixed models were used to compare healthcare resource utilization and costs between OF and non-OF cohorts for each country adjusting for potential covariates that remain unbalanced (standardized difference ≥10%) after matching.

RESULTS: Across all five countries, the OF cohort had significantly higher rates of inpatient admissions (1.16 to 3.90-fold increase) and hospital length of stay (1.71 to 11.52-fold increase) compared to non-OF cohort. In each country, the adjusted direct medical cost ratios (comparing OF vs. non-OF) were statistically significant ranging from 1.38 in Germany (95% CI: 1.35-1.41) to 3.11 in the US (95% CI: 3.09-3.13). The adjusted cost ratios for pharmacy, medical inpatient, emergency care and outpatient visits were similarly higher in the OF cohort across countries.

CONCLUSIONS: These results demonstrated the substantial economic burden of OF across the five participating countries. More efforts should be made to alleviate the burden. The adjusted rate ratio approach pioneered in this study minimized potential concern of methodological variance when data were compared across countries.