To assess the cost-effectiveness of interventions to prevent osteoporosis, it is necessary to estimate total health care expenditures for the treatment of osteoporotic fractures. Resources utilized for the treatment of many diseases can be estimated from secondary databases using relevant diagnosis codes, but such codes do not indicate which fractures are osteoporotic in nature. Therefore, a panel of experts was convened to make judgments about the probabilities that fractures of different types might be related to osteoporosis according to patient age, gender, and race. A three-round Delphi process was applied to estimate the proportion of fractures related to osteoporosis (i.e., the osteoporosis attribution probabilities) in 72 categories comprised of four specific fracture types (hip, spine, forearm, all other sites combined) stratified by three age groups (45-64 years, 65-84 years, 85 years and older), three racial groups (white, black, all others), and both genders (female, male). It was estimated that at least 90% of all hip and spine fractures among elderly white women should be attributed to osteoporosis. Much smaller proportions of the other fractures were attributed to osteoporosis. Regardless of fracture type, attribution probabilities were less for men than women and generally less for non-whites than whites. These probabilities will be used to estimate the total direct medical costs associated with osteoporosis-related fractures in the United States.

译文

为了评估预防骨质疏松症的干预措施的成本效益,有必要估算用于治疗骨质疏松性骨折的医疗保健总支出。可以使用相关的诊断代码从二级数据库中估算用于治疗许多疾病的资源,但是这些代码并未指出哪些骨折本质上是骨质疏松的。因此,召集了一个专家小组,根据患者的年龄,性别和种族来判断不同类型的骨折可能与骨质疏松症有关的可能性。采用三轮Delphi程序来估计与骨质疏松症相关的骨折的比例 (即骨质疏松症归因概率),包括由三个年龄组 (45-64岁,65-84岁,85岁及以上),三个种族群体 (白人,黑人,所有其他) 和两个性别 (女性,男性)。据估计,在老年白人妇女中,至少90% 的髋部和脊柱骨折应归因于骨质疏松症。其他骨折的比例要小得多,这归因于骨质疏松症。无论骨折类型如何,男性的归因概率低于女性,非白人的归因概率通常低于白人。这些概率将用于估算美国与骨质疏松症相关的骨折相关的总直接医疗费用。

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