Long-term cost and effect on quality of life of osteoporosis-related fractures in Sweden.

BACKGROUND AND PURPOSE: Few economic or quality-of-life studies have investigated the long-term consequences of fragility fractures. This prospective observational data collection study assessed the cost and quality of life related to hip, vertebral, and wrist fracture 13-18 months after the fracture, based on 684 patients surviving 18 months after fracture. PATIENTS AND METHODS: Data regarding resource use and quality of life related to fractures was collected using questionnaires at 7 research centers in Sweden. Information was collected using patient records, register sources, and by asking the patient. Quality of life was estimated using the EQ-5D questionnaire. Direct and indirect costs were estimated from a societal standpoint. RESULTS: The mean fracture-related cost 13-18 months after a hip, vertebral, or wrist fracture were estimated to be euro2,422, euro3,628, and euro316, respectively. Between 12 and 18 months after hip, vertebral, and wrist fracture, utility increased by 0.03, 0.05, and 0.02, respectively. Compared to prefracture levels, the mean loss in quality of life between 13 and 18 months after fracture was estimated to be 0.05, 0.11, and 0.005 for hip, vertebral, and wrist fracture. INTERPRETATION: The sample of vertebral fracture patients was fairly small and included a high proportion of fractures leading to hospitalization, but the results indicate higher long-term costs and greater loss in quality of life related to vertebral fracture than previously believed.

Costs and quality of life associated with osteoporosis-related fractures in Sweden.

This prospective observational data collection study assessed the cost and quality of life related to hip, vertebral and wrist fracture 1 year after the fracture, based on a patient sample consisting of 635 male and female patients surviving a year after fracture. Data regarding resource use and quality of life related to fractures was collected by questionnaires at baseline, 4 months and 12 months. Information was collected by the use of patients' records, register sources and by asking the patient. Quality of life was estimated with the EQ-5D questionnaire. Costs were estimated from a societal perspective, including direct and indirect costs. The mean fracture-related cost the year after a hip, vertebral and wrist fracture were estimated, in euros (), at 14,221, 12,544 and 2,147, respectively [converted from Swedish krona (SEK) at an exchange rate of 9.1268 SEK/]. The mean reduction in quality of life was estimated at 0.17, 0.26 and 0.06 for hip, vertebral and wrist fracture, respectively. Based on the results, the yearly burden of osteoporosis in Sweden could be estimated at 0.5 billion (SEK 4.6 billion). The patient sample for vertebral fracture was fairly small and included a high proportion of fractures leading to hospitalization, but they indicate a higher cost and loss of quality of life related to vertebral fracture than previously perceived.

Hemicallotasis for medial gonarthrosis: a short-term follow-up of 21 patients.

We have prospectively evaluated 21 patients (22 knees; 15 men and 6 women) who underwent hemicallotasis osteotomy (HO), using an external fixator, of the proximal tibia due to medial gonarthrosis. Their median age at the time of operation was 52 (range 39-62) years. The follow- up period was 12-28 months. The Hospital for Special Surgery score (HSS) increased from median 71 preoperatively to 83 points at the follow-up ( p < 0.001). The median hip-knee-ankle angle (HKA) was 187 degrees preoperatively, 177 degrees after distraction, and 180 degrees at the time of follow-up ( p < 0.001). In 5 knees, valgus angulation was not achieved during the distraction phase, and in two-thirds of the knees, there was no valgus at follow-up. The total time in external fixation was median 13 (range 8-16) weeks. Pin tract problems occurred in 12 cases. There was one deep vein thrombosis, and 2 patients had to undergo re-operations due to technical errors. One patient acquired a bacterial arthritis 6 months after the operation. The clinical short-term results with HO seem to be comparable to those reported earlier for closing-wedge osteotomy. However, HO is a trying procedure for the patient as well as for the surgeon, due to frequent minor complications requiring frequent follow-ups.