Longitudinal patient outcomes over 18 months following a hip, clinical vertebral, distal forearm, or proximal humerus fracture in the United States: results from the ICUROS US study.

Abstract

The longitudinal impact of fractures associated with osteoporosis on costs and health-related quality of life is not well understood. The objective of this study was to characterize these outcomes over an 18-mo period following 4 common fracture types. Patients aged over 50 yr at 7 study sites with a diagnosis of incident hip, distal radius, proximal humerus, or vertebral fracture were enrolled in the International Costs and Utilities Related to Osteoporotic Fracture Study US. Data collection by questionnaire occurred at baseline (within 6 wk of fracture), 4-, 12-, and 18-mo post-fracture. Direct, indirect, and total costs were estimated over an 18-mo period and are reported in 2020 US Dollars. Health utilities were measured using EuroQol EQ-5D and the SF-6D. We performed longitudinal regression models of estimated costs adjusted for age and sex. We enrolled 284 patients with single fragility fractures (58 hip, 50 distal radius, 32 proximal humerus, 144 vertebral). Mean ages were 68.1 yr for distal radius and proximal humerus and 76 yr for hip patients. Most participants were women (76%-84% women). Over the 18-mo study period, direct costs (Including initial fracture and fracture related follow-up costs) were $18 495 for hip, $3451 for distal forearm, $6009 for humerus, and $9274 for vertebral fracture. Mean indirect costs were $9250 for hip, $1772 for distal radius, $4195 for humerus, and $4084 for vertebral fracture. Adjusted mean EQ-5D differences (95% CI) at 18-mo for those surviving/reporting compared with baseline were: hip -0.162 (95% CI, -0.22 to -0.103), distal radius -0.017 (95% CI, -0.056 to 0.022), proximal humerus -0.064 (95% CI, -0.103 to -0.0248), and vertebral -0.044 (95% CI, -0.083 to -0.0048). Substantial direct and indirect costs are observed in the 18-mo following 4 common osteoporotic fractures. Significant changes in health utility persisted for all fractures other than distal radius fractures regardless of the health utility measure used.