Osteoporosis is a skeletal disease characterized by a reduction in bone mass and microstructures and a decline in bone tissue that is associated with increased fragility and increased risk of fracture (1). Osteoporosis is one of the main threats of aging, and its prevalence among people aged over 50 years is 30% in women and 15% in men (2). Osteoporosis is characterized by a decrease in bone mineral content along with bone matrix, so that bone loss is reduced but bone composition remains normal(3).
Bone fractures are the most important complication of osteoporosis (1). The fractures lead to increased mortality, disability, and increased medical costs. Osteoporosis is more common in women than in men. The disease is manifested when bone fractures occur, especially in the vertebral and pelvic areas (4).
In 2010, the estimated number of osteoporotic fractures in the European Union was 3.5 million cases, which included 620,000 cases of hip fractures, 520,000 cases of spine fractures, 560,000 cases of forearm fractures, and 1,800,000 cases of other types of fracture. The number of annual cases of osteoporotic fractures is expected to reach 4.5 million cases by 2025 (5).
Osteoporosis and its fractures not only have a major impact on health and quality of life, but also impose a significant economic burden on the health system (1). The economic costs of a disease can be used to estimate the burden of that disease. The costs in the economy are divided into two groups, including direct and indirect costs. The direct costs are the treatment costs and the indirect costs are the costs associated with days off from work or school due to illness (6). The costs associated with osteoporosis in the European Union in 2010 were estimated to be 37 billion euros, more than 70% of which is related to the costs of fractures caused by osteoporosis (2). In 2005, the direct medical costs of osteoporosis in the United States were estimated to be 13.7 to 20.3 billion dollars. It is also projected that by 2025, more than 3 million cases of osteoporotic fracture will occur annually, with an estimated cost of 25.3 billion dollars (7, 8). In 2005, the cost of every case of hip fracture in the United States was estimated to be 13,240 to 35,600 dollars annually, and the cost of osteoporotic fractures in the United States is estimated to be 20 billion dollars annually (1). Pelvic bone fractures are the most common type of fracture and are most prevalent type associated with mortality (7). This type of fracture is also the most expensive type of fracture (1).
Among the different components of health care systems, hospitals are facing a shortage of resources as a challenge, and every type of shortage of resources leads to a competition. Under such a condition and competition, only the organizations that could reduce the costs while paying attention to the quality of services provided can be successful. Therefore, cost information in the hospital can be of great value in optimizing resource allocation, modifying budgets, reducing waste costs, and making more efficient use of available resources. The objective of every cost detection and cost management system is to provide accurate and practical information to help organizations deliver quality goods and services under a competitive setting (9).
The prevalence of osteoporosis increases with aging that is due to decreased bone tissue. Due to the decline of ovarian function in women during the post-menopausal period, the loss of bone mass is accelerated and as a result most of women have the indications for the diagnosis of osteoporosis at the age of 70-80 years (10).
Since the population of most Asian countries is aging, the incidence of fractures due to osteoporosis is also increasing in these countries. More than 50% of hip fractures are projected to occur in Asian countries by 2050 (5). The average prevalence of osteoporosis in Iran in 2012 was 17% (11).
Osteoporosis is preventable and treatable, but since it is a latent disease it is usually undetectable until the final stages (12). Osteoporosis is a complex disease that is influenced by several factors, some of which are uncontrollable, such as age, sex, race, family history, menopause, and some other factors such as weight, mobility, nutrition, and smoking (10). Bone ability to cope with fracture is dependent on several factors including bone mass, bone shape, and intrinsic characteristics of bone (13). There are several recommendations for preventing osteoporosis, for instance it is recommended to adopt a diet high in calcium and vitamin D and have a daily intake of calcium-rich foods, especially low-fat and pasteurized dairy products (9). Different treatment strategies such as behavioral changes, use of pelvic protectors and analgesics, and use of muscle relaxants, heat, massage, and rest can reduce the risk of osteoporotic fractures (10). The risk and frequency of fractures vary by race, so they should be investigated individually in every population group (14).
Half of women and one-fifth of men aged over 50 years are at risk of fractures in their life. The serious complications of fracture are mortality, pain, and loss of quality of life (15). The rate of mortality from hip and spine fractures is approximately 20%. The total DALY due to osteoporotic fractures in 2000 was 5.8 million years, which is somewhat higher than that of hypertension and rheumatism. The economic burden on this disease in women is higher than that in men, with 64% of DALY observed in women. In a study on osteoporosis burden in Iran in 2001, the years of life lost (YLL) due to osteoporotic fractures was 32,375 years for hip fractures, 3,493 years for spine fractures, and 158 years for forearm fractures. In total, osteoporosis resulted in 36,027 years of life lost due to premature death and disability (14).
According to the latest statistics, in Iran about 25,969,046 people suffer from osteopenia and 3,024,798 people suffer from osteoporosis, which respectively will reach 40,303,730 and 3,592,708 by 2020. Based on the results of studies conducted by Tehran University of Medical Sciences in 2001 and 2004, considering the DALY scale, osteoporosis was responsible for the loss of more than 36,000 years of life among Iranian men and women. Thus, Iran accounts for about 0.85% of the global burden of osteoporosis and 12.4% of the burden of osteoporotic fractures in the Middle East (10).
As mentioned above, due to increased life expectancy and an increasing percentage of the elderly population in recent years, the incidence and prevalence of osteoporosis and related fractures have been increasing, and this disease has become one of the most common diseases. In addition, advances in medical technology and the introduction of new and sometimes costly preventive and therapeutic methods have made the disease economically striking. Studies carried out in Western and some Asian countries have shown that osteoporosis imposes a significant economic burden on communities, and its related costs are rising in most countries, especially Asian countries, including Iran. Given the important role of information about the costs and economic aspects of osteoporosis in making policies and planning measures for the prevention and management of this disease, this study systematically investigated the evidence and data on the costs of osteoporosis in the world. The data was analyzed through reviewing existing studies and it aimed at better assessing the economic burden of osteoporosis in different countries around the world.