Outpatient costs of osteoporosis in a national health insurance population

There are few valid data on the outpatient diagnosis and treatment of osteo porosis in Germany, despite the high prevalence of this disease and the hig h costs associated with its complications. We therefore conducted a retrosp ective cohort study to investigate the prevalence of documented osteoporosi s and the use of health care resources in its outpatient treatment in a rep resentative random sample of 7490 patients from the Dresden area who were i nsured under the national health insurance program for a 1-year period from the 3rd quarter of 1993 to the 2nd quarter of 1994. Documented cases of os teoporosis were identified by International Statistical Classification of D iseases, 10th Revision diagnostic codes M80 to M82, and the costs of diagno stic services for osteoporosis were calculated using a uniform fee schedule . Specific and nonspecific osteoporosis medications were classified using a published anatomic-therapeutic-chemical code, and their costs were calcula ted on the basis of pharmacy sales prices. Three age- and sex-matched contr ols without documented osteoporosis (n = 705) were assigned for each case p atient in estimating the net use of resources. Data for the region, as well as age-standardized information for the overall German national health ins urance system, were calculated. The 1-year prevalence of documented osteopo rosis in the region was 3.14% (5.20% in women, 0.89% in men), and the age-s tandardized prevalence in the German national health insurance system was 2 .25%. During the study period, 51.1% of the cases and 2.1% of the controls were examined by osteodensitometry. Patients received 106 defined daily dos es of osteoporosis medications during the year; 37.0% of the prescribed dai ly doses were for sodium fluorophosphate/calcium combinations, 4.3% were fo r sodium fluoride, and 7.7% were for calcium alone. Sex hormones and calcit onin each accounted for 7.7% of the prescribed daily doses. Only afraction of epidemiologically expected cases of osteoporosis have been identified an d documented in the outpatient sector. Only similar to 50% of these receive osteoporosis-specific therapy, and compliance-with therapy is low. To redu ce osteoporosis-associated fracture rates, which are extremely cost intensi ve and greatly impair patients' quality of life, more consistent treatment is needed.