Incidence and Cost of Clinically Recognized Vertebral Fracture in China

Background: Osteoporotic vertebral fractures cause pain and disability, which result in heavy socioeconomic burden. However, the incidence and cost of vertebral fractures in China are unknown.Methods: This population-based cohort study was conducted by using Urban Employee Basic Medical Insurance (UEBMI) and Urban Resident Basic Medical Insurance (URBMI) data in China from 2013 to 2017, which covered more than 95% of the Chinese population in urban areas. The incidence and cost of clinically recognized vertebral fractures among people aged 50 years and older in China from 2013 to 2017 were calculated. Vertebral fractures were identified by the primary diagnosis (i.e., International Classification of Diseases code or text of diagnosis) in UEBMI and URBMI.Findings:A total of 271,981 vertebral fractures (186,428, 68.5% females and 85,553, 31.5% males) were identified, with a mean age of 70.26 years. The incidence of vertebral fractures among patients aged 50 years and over in China increased approximately 1.79-fold during the five years, from 85.21 per 100,000 person-years in 2013 to 152.13 per 100,000 person-years in 2017. Medical costs for vertebral fracture increased from US$92.74 million in 2013 to US$505.3 million in 2017. Annual costs per vertebral fracture case increased from US$3.54 thousand in 2013 to US$5.35 thousand in 2017.Interpretation: The dramatic increase in the incidence and cost of clinically recognized vertebral fracture among patients aged 50 and over in urban China implies that more attention should be given to the management of osteoporosis to prevent osteoporotic fractures.Funding: This work was supported by the National Key Research and Development Program(2020YFC2009004, 2021YFC2501700), the National Natural Science Foundation ofChina (81874010) and PKU-Baidu Fund (2020BD014).Declaration of Interest: All authors report there are no conflicts of interest related to the present article.Ethical Approval: This study was approved by the ethical review committee of the Peking University Health Science Center (IRB. No.: IRB00001052-18012), and the informed consent requirement was waived.