Morbidity, mortality and cost of osteoporotic fractures—should proximal humerus fractures be taken as seriously as hip fractures?

Abstract

Background: Proximal humerus fractures are common in the population over age 65. Several studies have demonstrated high morbidity and mortality rates associated with several osteoporotic fracture types. The purpose of this study was to investigate and compare the risk factors, morbidity, mortality and cost of proximal humerus, distal radius, hip and vertebral compression fractures. Methods: From the Medicare Registry, patients diagnosed with a proximal humerus, distal radius, hip or vertebral compression fracture based on the ICD-9 coding were identified. Sex, race, age, fracture type, healthcare cost, mortality, blood transfusion requirement, and comorbidities were documented. Results: Between 2010 and 2014 there were 50,237,330 inpatient claims and 1,183,966 (2.4%) of those were specifically for 1 of the 4 osteoporotic fracture types. Mortality rate during index admission for all four fractures combined was 2.2%. Mortality rate was 1% for proximal humerus, as compared to 0.4% for distal radius, 2.5% for hip and 1.8% for vertebral compression fractures. The highest cost was associated with hip fractures and the lowest cost with distal radius fractures. The hip and vertebral compression fracture patients had the most documented comorbidities. Patients were more likely to be female (OR 2.105, 95% CI: 2.096–2.113), white (OR 2.600, 95% CI: 2.582–2.617), and over 84 years of age (OR 5.979, 95% CI: 5.957–6.001) in all fracture types. Conclusions: Proximal humerus fractures carry similar risk factors, morbidity, mortality, and health care costs as other osteoporotic fracture types. The findings of the present study are clinically relevant, as life expectancy continues to increase and the Medicare population continues to grow. This will lead to an increase in the incidence of osteoporotic fractures. Proper screening and treatment of osteoporosis may help prevent some of these fractures.