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*253. Osteoporotic Fractures in Veterans: an Opportunity to Improve Care and Reduce Costs

A Ohldin, Birmingham VA Medical Center, National VA Quality Scholar Program; C Kiefe, Birmingham VA Medical Center, National VA Quality Scholar Program

Objectives: Osteoporosis affects over 20 million Americans and has emerged as a major public health problem. Complications of osteoporosis such as hip and other fractures result in significant incremental health care costs. Osteoporosis is a disorder, which is increasing in incidence, prevalence, and mortality. Hip fractures, overwhelmingly caused by osteoporosis, account for 300,000 hospital admissions and annual cost estimates range from $15 billion to $30 billion. A number of options exist for risk reduction attributed to osteoporosis which include exercise, calcium, vitamin D, estrogens, and bisphosphonates. We examined the incidence, and medical costs associated with hip fractures among Veterans by gender and race / ethnic origin. We then ascertained the proportion of these Veterans with a diagnosis of osteoporosis.

Methods: We identified Veterans with a diagnosis of hip fracture (DRG 236) during FY 1998 and FY1999 from the VA Patient Treatment File (PTF) database,and ascertained whether a diagnosis of osteoporosis was also listed for each case of hip fracture. We based medical cost inferences on VA and Medicare discharge and cost data, for 1998 and 1999. We excluded patients with metastatic malignancies; prostate, lung, breast, thyroid, or renal cancer; multiple myeloma; or chronic renal failure, in order to identify those cases that were likely due to underlying , undiagnosed osteoporosis.

Results: In FY1998, 2,623 Veterans were hospitalized for hip fractures while 2620 were hospitalized in FY 1999. After applying the listed exclusions, 2510 remained in FY 1998 and 2501 in FY1999. In 1998, a diagnosis of osteoporosis was listed for 11 of 2406 (0.46%) of male and 8 of 104 (7.69%) of female veterans who were hospitalized with hip fractures. In 1999, a diagnosis of osteoporosis occurred for 16 of 2395 (0.67%) of male and 10 of 106 (9.43%) of female veterans who were hospitalized with hip fractures. The diagnosis of osteoporosis was present only for the race / ethnic origin White Veterans with hip fractures. We estimated that hip fractures result in 52 million dollars of excess cost to Veterans and the VA annually.

Conclusions: White Veterans hospitalized for hip fracture secondary to osteoporosis rarely had the diagnosis of osteoporosis listed in the PTF. Male gender was associated with lower frequencies of osteoporosis diagnoses than female gender. Non-White Veterans never had this diagnoses listed. This suggests that osteoporosis is markedly underdiagnosed and undertreated in the veteran population with hip fracture.

Impact: Osteoporotic hip fractures are preventable. Use of primary and secondary preventive measures represent an opportunity for improvement of care as well as substantial cost savings for Veterans.