Background/Purpose: Osteoporosis-related fractures (fractures) are a leading cause of morbidity and disability in the US. Epidemiological data on the occurrence of fractures are limited and required to inform healthcare providers, payers, and policymakers on the scope of this disease. The objective of this analysis was to assess the incidence of fractures in a population of managed care enrollees over the past decade.

Methods: The study included commercial and Medicare Advantage health plan members who had evidence of a qualifying fracture between Jan 2007 and May 2017 (identification period). Fractures were considered qualifying if they were either identified during an inpatient stay or were identified in an outpatient setting based on primary or secondary ICD-9 or ICD-10 accompanied by a repair procedure code. Patients ≥50 years of age with evidence of a qualifying fracture were included. The denominator population comprised members who were ≥50 years of age during the year of interest. The number of days the member was enrolled in the health plan during the year was calculated and was used to determine the total person-years (py) of enrollment for the denominator. Incidence rate is reported as number of events per 1000 py of enrollment during each year from 2007-May 2017. Rates are presented stratified by age category (50-64 vs ≥65) and gender (male vs. female). Patients were categorized by 5-year age increments and gender, and an overall age-gender adjusted rate was calculated.

Results: Of 1,841,263 members with fractures in the identification period, 513,176 met the eligibility criteria. The overall age-gender adjusted rate fell from 14.67/1000 py in 2007 to 11.80/1000 py in 2012, and then did not decrease from 2013- May 2017. Among females ≥65 years old the incidence of fractures declined from 27.49/1000 py in 2007 to 22.08/1000 py in 2013, and then did not decrease from 2014- May 2017. Similarly, among males ≥65 years old incidence decreased from 12.00/1000 py in 2007 to 10.72/1000 py in 2013 and then did not decrease from 2014- May 2017. For males and females ages 50-64 the rates were consistent across years, approximately 4.2 and 7.2 fractures per 1000 py, respectively.

Conclusion: The current study findings suggest fracture incidence has remained the same and potentially rising since 2014. The current study results may reflect insufficient diagnosis and treatment of osteoporosis and support the call to action to increase diagnosis and treatment of osteoporosis especially in older adults.