Fractures are associated with significant increases in health services utilization compared to prefracture levels. Relative to the prior 6-month period, rates of acute hospitalization are between 19.5 (distal radius/ulna) and 72.4 (hip) percentage points higher in the 6 months after fractures. Average acute inpatient days are 1.9 (distal radius/ulna) to 8.7 (hip) higher in the postfracture period. Fractures are associated with large increases in all forms of postacute care, including postacute hospitalizations (13.1% to 71.5%), postacute inpatient days (6.1% to 31.4%), home health care hours (3.4% to 8.4%), and hours of physical (5.2% to 23.6%) and occupational (4.3% to 14.0%) therapy. Among patients who were initially community dwelling at the time of the initial fracture, 0.9% to 1.1% were living in a nursing home 6 months after the fracture. These rates rose by 2.4% to 4.0% one year after the fracture.1

INSTITUTIONALIZATION

Since 1980, there has been a nearly 15% decrease in the prevalence of chronic disability and institutionalization among people aged 65 years and older. A drop in disability translates directly into cost savings since it is seven times more expensive to care for a disabled senior versus a healthy one. Major activity limitations are a common cause of nursing home admissions. While the most common cause of limitations is arthritis, affecting nearly 50% of people older than 65 years and an estimated 60 million by 2020.2 Hip fractures are a second source of immobility, and are projected to reach 289,000 in the year 2030, nearly all fall-related.3

FRACTURES AND MORTALITY

Vertebral and hip osteoporotic fractures result in a 20% increase in mortality, usually observed in the 12 months after the fracture. Men, who are generally older at the time of the hip fracture, have a 30% mortality rate after the fracture. Moreover, comorbidities such as cardiovascular disease contribute to a higher mortality rate.

A population-based study in Olmsted County, MN, found that within the first seven days after hip fracture repair, 116 (10.4%) of participants experienced myocardial infarction and 41 (3.7%) subclinical myocardial ischemia. Overall, the 1-year mortality was 22%, with no difference between those with subclinical myocardial ischemia and those with no myocardial ischemia. One-year mortality for those with a myocardial infraction was significantly higher (35.8%) than for the other two groups.4 The relative mortality after vertebral fracture varies from 1.2 to 1.9 in different reports,5^,6 but the excess deaths occur late, rather than early, after vertebral fractures.5

• 1. Kilgore ML, Morrisey MA, Becker DJ, et al.: Health care expenditures associated with skeletal fractures among Medicare beneficiaries, 1999–2005. J Bone Miner Res 2009;24(12):2050-2055.
• 2. National Academy on An Aging Society: Arthritis: A leading cause of disability in the United States. Chronic and Disabling Conditions. 2000;5. http://www.agingsociety.org/agingsociety/publications/chronic/index.html Accessed June 22, 2015.
• 3. Centers for Disease Control and Prevention: Hip Fractures Among Older Adults. http://www.cdc.gov/HomeandRecreationalSafety/Falls/adulthipfx.html  Accessed June 22, 2015.
• 4. Huddleston JM, Gullerud RE, Smither F, et al.: Myocardial infarction after hip fracture repair: A population-based study. J Am Geriatr Soc 2012;60(11):2020-2026.
• 5. a. b. Kado DM, Browner WS, Palermo L, et al.: Vertebral fractures and mortality in older women: A prospective study. Arch Intern Med 1999;159(11):1215-1220.
• 6. Center JR, Nguyen TV, Schneider D, Sambrook PN, Eisman JA: Mortality after all major types of osteoporotic fracture in men and women: An observational study. Lancet 1999;353(9156):878-882.