Background: The United States Bone and Joint Initiative (USBJI) reports the recent burden of osteoporosis, focusing on prevalence, fractures, health care utilization, and economic burden.
Methods: To provide the current prevalence of osteoporosis, we reviewed studies providing prevalence estimates based on bone mineral density (BMD). We used the 2010-2014 National Inpatient Sample (NIS) and the National Emergency Department Sample (NEDS) to provide prevalence of major fragility fractures (hip, spine, pelvis, femur, wrist, and humerus) and to assess temporal trends in fragility fractures. We used NIS data to evaluate health care utilization, and the Medical Expenditures Panel Survey (MEPS) data to estimate the economic burden of osteoporosis care.
Results: Based on recent National Health and Nutrition Examination Survey (NHANES) data, the overall prevalence of osteoporosis, using femoral neck and lumbar spine BMD, in US adults age 50+ was 11.0%, with higher prevalence in women (16.5%) than men (5.1%). The highest prevalence was in Asians (women: 40.0%, men: 7.5%), followed by Hispanics, non-Hispanic Whites, and non-Hispanic Blacks. Prevalence varied by Hispanic origin, with higher prevalence in Puerto Rican men than in men of other races/ethnicities (8.6%; Hispanic: 2.3%; NH-White: 3.9%). We estimated that 2.8% of the 19.5 million discharges in NIS data and 0.9% of the 46.7 million ED visits were for fragility fractures. Fracture prevalence differed by sex, age, and race/ethnicity, with women, those 80+, and non-Hispanic Whites having the highest prevalence at all fractures sites. From 2010 to 2014, we observed a decrease in all fracture sites, ranging from 12% to 22%; however, we observed 3.5% and 1.4% increase in the number of hip and femur fracture discharges, respectively. The mean LOS (SD) for all fragility fractures was 5.3 (0.87) days, with the longest LOS for femur (6.1 days) and the shortest for wrist fractures (3.6 days). Men, younger individuals, and non-Hispanic Blacks had longer LOS than their comparator groups. Total aggregate direct costs for persons with osteoporosis were $73.6 billion in 2012-2014, a rise of 118% from the $28.1 billion in 1998-2000, with fairly equal distribution between ambulatory care, inpatient, and prescription costs.
Conclusions: Osteoporosis remains highly prevalent and a costly condition in older adults. These new prevalence estimates seek to increases osteoporosis awareness and prevention.