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Non-hip, non-spine fractures drive healthcare utilization following a fracture: the Global Longitudinal Study of Osteoporosis in Women (GLOW)

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Abstract

Summary

We evaluated healthcare utilization associated with treating fracture types in >51,000 women aged ≥55 years. Over the course of 1 year, there were five times more non-hip, non-spine fractures than hip or spine fractures, resulting in twice as many days of hospitalization and rehabilitation/nursing home care for non-hip, non-spine fractures.

Introduction

The purpose of this study is to evaluate medical healthcare utilization associated with treating several types of fractures in women ≥55 years from various geographic regions.

Methods

Information from the Global Longitudinal Study of Osteoporosis in Women (GLOW) was collected via self-administered patient questionnaires at baseline and year 1 (n = 51,491). Self-reported clinically recognized low-trauma fractures at year 1 were classified as incident spine, hip, wrist/hand, arm/shoulder, pelvis, rib, leg, and other fractures. Healthcare utilization data were self-reported and included whether the fracture was treated at a doctor’s office/clinic or at a hospital. Patients were asked if they had undergone surgery or been treated at a rehabilitation center or nursing home.

Results

During 1-year follow-up, there were 195 spine, 134 hip, and 1,654 non-hip, non-spine fractures. Clinical vertebral fractures resulted in 617 days of hospitalization and 512 days of rehabilitation/nursing home care; hip fractures accounted for 1,306 days of hospitalization and 1,650 days of rehabilitation/nursing home care. Non-hip, non-spine fractures resulted in 3,805 days in hospital and 5,186 days of rehabilitation/nursing home care.

Conclusions

While hip and vertebral fractures are well recognized for their associated increase in health resource utilization, non-hip, non-spine fractures, by virtue of their 5-fold greater number, require significantly more healthcare resources.

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Acknowledgment

We thank the physicians and project coordinators participating in GLOW. Editorial support for the final version of this article, comprising language editing, content checking, formatting and referencing was provided by Sophie Rushton-Smith, PhD. Dr Boonen is senior clinical investigator of the Fund for Scientific Research, Flanders, Belgium (FWO-Vlaanderen) and holder of the Leuven University Chair in Metabolic Bone Diseases. Financial support for the GLOW study is provided by Warner Chilcott Company, LLC and Sanofi–Aventis to the Center for Outcomes Research, University of Massachusetts Medical School. The sponsor had no involvement in the design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation, review, or approval of the manuscript.

Conflicts of interest

George Ioannidis: None.

Julie Flahive: The Alliance for Better Bone Health (sanofi-aventis and Warner Chilcott).

Laura Pickard: None.

A Papaioannou: Consultant/Speaker, Honoraria, or Grants: Eli Lilly, Amgen, Merck, Novartis, Procter & Gamble, sanofi-aventis, and Servier.

Roland Chapurlat: French Ministry of Health, Merck, Servier, Lilly, Procter and Gamble. Speakers’ Bureau: none. Honoraria: Amgen, Servier, Novartis, Lilly, Roche, sanofi-aventis. Consultant/Advisory Board: Amgen, Merck, Servier, Nycomed, Novartis.

Kenneth G Saag: Speakers’ bureau: Novartis. Consulting fees or other remuneration: Eli Lilly & Co., Merck, Novartis, Amgen, Roche, Proctor & Gamble, sanofi-aventis. Paid research: Eli Lilly & Co, Merck, Novartis, Amgen, Proctor & Gamble, sanofi-aventis. Advisory Committee or other paid committee: Eli Lily & Co.

Stuart Silverman: Research grants: Wyeth, Lilly, Novartis, Alliance. Speakers’ bureau: Lilly, Novartis, Pfizer, Procter & Gamble. Honoraria: Procter & Gamble. Consultant/Advisory Board: Lilly, Argen, Wyeth, Merck, Roche, Novartis.

Frederick A Anderson has received research support from sanofi-aventis, The Medicines Company, Procter & Gamble, and Scios; has been a consultant for sanofi-aventis, GlaxoSmithKline, and Millennium and Sage; and has served on advisory boards for sanofi-aventis and The Medicines Company. Stephen Gehlbach: The Alliance for Better Bone Health (sanofi-aventis and Warner Chilcott).

Frederick H Hooven: The Alliance for Better Bone Health (sanofi-aventis and Warner Chilcott).

Steven Boonen: Research grant: Amgen, Eli Lilly, Novartis, Pfizer, Procter & Gamble, sanofi-aventis, Roche, GlaxoSmithKline. Speakers’ bureau: Amgen, Eli Lilly, Merck, Novartis, Procter & Gamble, sanofi-aventis, Servier. Honoraria: Amgen, Eli Lilly, Merck, Novartis, Procter & Gamble, sanofi-aventis, Servier. Consultant/Advisory Board: Amgen, Eli Lilly, Merck, Novartis, Procter & Gamble, sanofi-aventis, Servier.

Juliet Compston: Paid consultancy work: Servier, Shire, Nycomed, Novartis, Amgen, Procter & Gamble, Wyeth, Pfizer, Alliance for Better Bone Health, Roche, GlaxoSmithKline. Paid speaking engagements, reimbursement, and travel and accommodation: Servier, Procter & Gamble, Eli Lilly. Research grants from Servier R&D and Procter & Gamble. No stocks or shares in relevant companies.

Cyrus Cooper: has received consulting fees and lectured for AMGEN, The Alliance for Better Bone Health (sanofi-aventis and Warner Chilcott), Eli Lily, Merck Sharp and Dohme, Servier, Novartis, and Roche-GSK.

Adolfo Diez-Perez: Honoraria: Novartis, Eli Lilly, Amgen, Procter & Gamble, Roche. Expert Witness: Merck. Consultant/Advisory board: Novartis, Eli Lilly, Amgen, Procter & Gamble.

Susan L Greenspan: Consultant/advisory board: Amgen, Lilly, Merck. Research grants: The Alliance for Better Bone Health (sanofi-aventis and Proctor & Gamble), Lilly.

Andrea LaCroix: The Alliance for Better Bone Health (sanofi-aventis and Warner Chilcott).

Robert Lindsay: The Alliance for Better Bone Health (sanofi-aventis and Warner Chilcott).

J Coen Netelenbos: Paid consultancy work: Roche Diagnostics, Daiichi-Sankyo, Proctor & Gamble, Nycomed. Paid speaking engagements, reimbursement and travel and accommodation: Roche Diagnostics, Novartis, Daiichi-Sankyo, Procter & Gamble. Research grants: Alliance for Better Bone Health, Amgen.

Johannes Pfeilschifter: Research grant: AMGEN, Kyphon, Novartis, Roche. Other research support. Equipment: GE LUNAR. Speakers’ bureau: AMGEN, sanofi-aventis, GlaxoSmithKline, Roche, Lilly Deutschland, Orion Pharma, Merck Sharp and Dohme, Merckle, Nycomed, Procter & Gamble. Advisory Board membership: Novartis, Roche, Procter & Gamble, TEVA.

Maurizio Rossini: Speaker: Roche, Merck Sharp & Dohme, GlaxoSmithKline.

Christian Roux: Honoraria: Alliance, Amgen, Lilly, Merck Sharp and Dohme, Novartis, Nycomed, Roche, GlaxoSmithKline, Servier, Wyeth. Consultant/Advisory board: Alliance, Amgen, Lilly, Merck Sharp and Dohme, Novartis, Nycomed, Roche, GlaxoSmithKline, Servier, Wyeth.

Philip N Sambrook: Honoraria: Merck, sanofi-aventis, Roche, Servier. Consultant/Advisory board: Merck, sanofi-aventis, Roche, Servier.

Ethel S Siris: Consultant: Amgen, Lilly, Novartis, and the Alliance for Better Bone Health. Speakers’ Bureau: Amgen, Lilly. Nelson B Watts: Stock options/holdings, royalties, company owner, patent owner, official role: none. Honoraria for lectures in past year: Amgen, Novartis, Procter & Gamble, sanofi-aventis. Consulting in past year: Amgen, Baxter, InteKrin, Johnson & Johnson, MannKind, Novo Nordisk, NPS, Pfizer, Procter & Gamble, sanofi-aventis, Takeda Pharmaceuticals, Warner Chilcott. Research support (through University): Amgen, Eli Lilly, Merck, NPS.

Jonathan D Adachi: Consultant/Speaker: Amgen, Astra Zeneca, Eli Lilly, GlaxoSmithKline, Merck, Novartis, Nycomed, Pfizer, Procter & Gamble, Roche, sanofi-aventis, Servier, Wyeth and Bristol-Myers Squibb. Clinical trials for Amgen, Eli Lilly, GlaxoSmithKline, Merck, Novartis, Pfizer, Procter & Gamble, Roche, sanofi-aventis, Wyeth and Bristol-Myers Squibb. Stock: nothing to declare.

Author information

Authors and Affiliations

  1. St. Joseph’s Hospital, McMaster University, 501-25 Charlton Ave E, Hamilton, ON, L8N 1Y2, Canada

    G. Ioannidis, L. Pickard, A. Papaioannou & J. D. Adachi

  2. Center for Outcomes Research, University of Massachusetts Medical School, Worcester, MA, USA

    J. Flahive, F. A. Anderson Jr, S. H. Gehlbach & F. H. Hooven

  3. Division of Rheumatology, INSERM UMR 1033, Université de Lyon, Hospices Civils de Lyon, Hôpital E Herriot, Lyon, France

    R. D. Chapurlat

  4. University of Alabama at Birmingham, Birmingham, AL, USA

    K. G. Saag

  5. Department of Rheumatology, Cedars-Sinai Medical Center, Los Angeles, CA, USA

    S. Silverman

  6. Leuven University Center for Metabolic Bone Diseases, Division of Geriatric Medicine, Katholieke Universiteit Leuven, Leuven, Belgium

    S. Boonen

  7. University of Cambridge School of Clinical Medicine, Addenbrooke’s Hospital, Cambridge, UK

    J. E. Compston

  8. MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK

    C. Cooper

  9. Hospital del Mar-IMIM-Autonomous University of Barcelona, Barcelona, Spain

    A. Díez-Perez

  10. RETICEF, ISCIII Madrid, Madrid, Spain

    A. Díez-Perez

  11. University of Pittsburgh, Pittsburgh, PA, USA

    S. L. Greenspan

  12. Fred Hutchinson Cancer Research Center, Seattle, WA, USA

    A. Z. LaCroix

  13. Regional Bone Center, Helen Hayes Hospital, West Haverstraw, NY, USA

    R. Lindsay

  14. Department of Endocrinology, VU University Medical Center, Amsterdam, The Netherlands

    J. C. Netelenbos

  15. Department of Internal Medicine III, Alfried Krupp Krankenhaus, Essen, Germany

    J. Pfeilschifter

  16. Section of Rheumatology, Department of Medicine, University of Verona, Verona, Italy

    M. Rossini

  17. Paris Descartes University, Cochin Hospital, Paris, France

    C. Roux

  18. University of Sydney-Royal North Shore Hospital, St Leonards, Sydney, NSW, Australia

    P. N. Sambrook

  19. Columbia University Medical Center, New York, NY, USA

    E. S. Siris

  20. Bone Health and Osteoporosis Center, University of Cincinnati, Cincinnati, OH, USA

    N. B. Watts

Authors
  1. G. Ioannidis
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  2. J. Flahive
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  3. L. Pickard
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  4. A. Papaioannou
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  5. R. D. Chapurlat
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  6. K. G. Saag
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  7. S. Silverman
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  8. F. A. Anderson Jr
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  9. S. H. Gehlbach
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  10. F. H. Hooven
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  11. S. Boonen
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  12. J. E. Compston
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  13. C. Cooper
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  14. A. Díez-Perez
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  15. S. L. Greenspan
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  16. A. Z. LaCroix
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  17. R. Lindsay
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  18. J. C. Netelenbos
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  19. J. Pfeilschifter
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  20. M. Rossini
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  21. C. Roux
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  22. P. N. Sambrook
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  23. E. S. Siris
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  24. N. B. Watts
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  25. J. D. Adachi
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Correspondence to J. D. Adachi.

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Ioannidis, G., Flahive, J., Pickard, L. et al. Non-hip, non-spine fractures drive healthcare utilization following a fracture: the Global Longitudinal Study of Osteoporosis in Women (GLOW). Osteoporos Int 24, 59–67 (2013). https://doi.org/10.1007/s00198-012-1968-z

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  • DOI: https://doi.org/10.1007/s00198-012-1968-z

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