Report reveals geographic, racial disparities in fracture rates for older Americans
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A report from the National Osteoporosis Foundation details fracture rates for all 50 U.S. states and highlights ethnic and racial disparities among Medicare beneficiaries for hospitalization, mortality and health costs.
“This is a huge problem in the United States where we have a number of people fracturing from osteoporosis, and we’re not capturing those people,” Claire Gill, CEO of the National Osteoporosis Foundation, told Healio. “We’re not doing enough for those people. We have the tools already in place to address this crisis, and we’re not.”
The National Osteoporosis Foundation presented highlights from the report at a webinar March 30 with the aim that legislators will take action to improve access to fracture care and provide stronger education programs for older Americans.
Fracture rates, outcomes by state
The National Osteoporosis Foundation previously commissioned a report examining fractures in the Medicare population in 2019. The new report is the first to assess state-level data as well as data categorized by race.
According to the report, about 1.8 million Medicare beneficiaries experienced approximately 2.1 million osteoporotic fractures in 2016. Of those with Medicare fee-for-service coverage, more than 40% were hospitalized within 1 week of a fracture, including more than 90% of those sustaining a hip fracture. About 19% died within 12 months of a fracture, including about 30% of those with a hip fracture.
Fractures were associated with a sharp increase in medical costs. On average, per person medical costs were $21,564 in the 12 months after a fracture, and more than $30,000 for those who had a subsequent fracture. The total estimated allowed Medicare fee-for-service costs for subsequent fractures after an initial fracture were $5.7 billion, and preventing 20% of subsequent fractures could have saved nearly $1.1 billion in Medicare costs, according to the report.
Fracture rates by state, adjusted for age and sex, are included in the report. The national average number of fractures was 416.9 per 10,000 people in 2016. Hawaii had the lowest rate of new fractures at 24% below the national average. Kentucky had the highest rate of fractures at 13% above the national average, followed closely by Florida, which was 12% above the national average. Florida, California and Texas had the highest subsequent fracture rates at 16%, whereas North Dakota and Nebraska had the lowest at 11%. Mortality rates after a fracture were the highest in Rhode Island, Michigan and Ohio at 21%. Hawaii and Alaska had the lowest 12-month mortality rate at 14%.
Direct medical costs from subsequent fractures also varied widely, with Wyoming having the highest at a mean cost of $26,200 per person. Arkansas had the lowest cost at about $17,000 per person. Differences in population morbidity, unit costs and demographics all contributed the variation.
Gill said the data will allow education programs and interventions to be targeted toward certain areas and generate action by state governments.
“We have to do a little work with the states themselves, and I’m hoping we can reach out to the health departments in each state and look at what’s in place that is working to benefit fracture prevention,” Gill said.
Ethnic, racial disparities in fractures
The report revealed several ethnic and racial disparities in fracture rates and outcomes. Of five ethnicity groups included in the report, Native American adults had the highest fracture rate at 20% above the national average, and the rate was 6% above the national average for white adults. Hispanic adults had a fracture rate 19% below the national average, and the rate for adults of Asian descent was 32% below the national average.
Black adults had the lowest rate at 50% below the national average, but were more likely to experience poor outcomes from fractures. Black adults had a higher hospitalization rate than the national average, with 44.5% of people hospitalized within 7 days. In addition, the mortality rate for Black adults on Medicare sustaining a fracture was 22% within 12 months, higher than the national average of 19%. Black Medicare beneficiaries also had a lower screening rate compared with the national average (5% vs. 8%).
“Looking at this across the health disparities, we’re doing a horrible job with our minority population with addressing their fractures,” Gill said. “They may have less fractures, but if the outcomes from those fractures are drastically worse than they are for Caucasians, then we have a problem.”
According to the report, Black adults had a disproportionally high share of new tibia and fibula fractures. Asian beneficiaries had a higher rate of spine fractures as a share of their total fractures, whereas spine fractures were less common among Black and Native American adults.
Taking action
The National Osteoporosis Foundation intends to use the data to support several steps. The principal recommendation is to advocate for changes to Medicare payments to better promote secondary fracture prevention and care coordination after an initial fracture.
Another recommendation is to increase reimbursement rates for osteoporosis screening. Gill said cuts to reimbursement for DXA scans lowered the number of locations that provided them and decreased access to screening for some Americans, particularly those in rural areas. The organization is working with a fracture prevention coalition to propose legislation to Congress in May to raise reimbursement rates.
The final recommendation is for Congress to fund a national education campaign aimed at reducing fractures and falls among older adults. Gill said a greater focus on fracture education may help increase osteoporosis screening rates and lower the rates of subsequent fractures.
“Everyone’s more comfortable with the fall prevention discussion, which is fine, but the reason you want to prevent falls in older people is, if they have osteoporosis, they’ll fracture,” Gill said. “We’ve been working with the National Council on Aging and other partners since they do these fabulous programs, to add the fracture portion of that conversation.”
For more information:
Claire Gill can be reached at claire.gill@nof.org.
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