Impact of osteoporosis on high-cost chronic diseases.

Objective: To assess the impact of osteoporosis on health care costs for patients with chronic disease (CD): cardiovascular disease (CVD), chronic obstructive pulmonary disease (COPD), depression, diabetes mellitus (DM), or two or more of these CDs.

Methods: This retrospective analysis included commercially insured or Medicare Advantage male and female members aged 50 years or older with medical and pharmacy benefits who had evidence of osteoporosis and/or one of the CDs during the identification period (January 1, 2007, to October 31, 2009). Cohorts were defined by the presence or absence of osteoporosis and CD (osteoporosis ONLY, CD ONLY, and CD plus osteoporosis) and, for osteoporosis cohorts, by incident (recent diagnosis) or prevalent osteoporosis (long-standing). Primary outcome was total health care costs during 1-year follow-up. Costs, adjusted for baseline characteristics, were analyzed with a generalized linear model with log link and gamma distribution.

Results: Of the 494,160 patients, the majority had evidence of CD with or without osteoporosis: CVD (54%), two or more CDs (24%), DM (8%), depression (4%), COPD (1%); 9% had osteoporosis ONLY. The range of actual mean costs was as follows: CD ONLY, $8,377 (CVD) to $12,801 (two or more CDs); CD plus incident osteoporosis, $15,696 (CVD) to $23,860 (two or more CDs); CD plus prevalent osteoporosis, $10,038 (CVD) to $17,997 (two or more CDs). Compared with CD ONLY, baseline-adjusted costs were 66% (two or more CDs) to 91% (DM) higher for CD plus incident osteoporosis and 13% (CVD) to 23% (depression) higher for CD plus prevalent osteoporosis (P < 0.001).

Conclusions: The burden of osteoporosis in patients with CD is significant, particularly for patients with newly diagnosed osteoporosis.