OBJECTIVES: Herniated discs (HDs) and depression place a significant burden on employers.  Although less prevalent, fractures may also have associated burden.  The objective of this study was to evaluate the burden of fractures compared to HD and depression in terms of short-term disability (STD).METHODS: A descriptive retrospective analysis was conducted to assess STD associated with fractures (hip, nonvertebral composite, vertebral).  Medstat/MarketScan’s Health and Productivity Management data from 2003-2007 were used.  All patients were 45-64 year-old employees, stratified by gender.  Fracture-related STD was defined as STD absence 7 days prior to 14 days after the date of first diagnosis of fracture.  Cases were matched with a control with HD and a control with depression by age, gender, occupation, region, insurance type, and years of STD eligibility. RESULTS: HD and depression incidence was 30 and 55 per 1000 patient-years, respectively.  Fracture incidence ranged from 0.6 cases for hip to 7 cases for nonvertebral fractures per 1,000 patient-years.  However, a higher proportion of fracture patients had an STD absence compared to HD and depression controls.  The proportion of events with an STD absence in women was 16.4% vs. 5.1%, 16.5% vs. 3.5%, and 11.8% vs. 5.4% for hip, nonvertebral, and vertebral fractures vs. depression, respectively.  For men, the rates were 30.6% vs. 5.1%, 23.6% vs. 5.9%, and 23.7% vs. 6.7%.  Comparison to HD controls yielded similar results.  All p-values were <0.01.  Among fracture patients, the mean days of STD absence (MDA) ranged from 93 (nonvertebral) to 148 (hip).  The MDA was significantly higher (p<0.05) in women for vertebral (vs. HD controls) and in men for hip (vs. both controls), vertebral (vs. depression controls), and non-vertebral fractures (vs. depression controls). CONCLUSIONS: Although fracture incidence is lower than HDs or depression, fractures produce significantly higher STD burden per event in 45-64 year-old employees.