Healthcare Utilization


Lead Author(s): 

Nicole C. Wright, PhD, MPH
Marc C. Hochberg, MD, MPH, MACP, MACR

Supporting Author(s): 

Sylvia I. Watkins-Castillo, PhD

Osteoporosis and fractures are associated with increases in healthcare utilization, including hospitalization stays, physician office visits, and pharmacy use. We used NIS data to evaluate a variety of healthcare utilization characteristics by fracture site and a variety of demographic characteristics.


Hospitalization, Length of Stay


In 2014, the mean (standard deviation (SD)) length of stay (LOS) for all fragility fractures is 5.3 (0.87) days. The LOS was the highest for femur fractures (6.1 days) and the lowest for wrist fractures (3.6 days). When evaluating by sex, men tended to have longer LOS than women for all fracture sites. (Reference Table 4A.3.1 PDF CSV)

Overall, it appeared that younger individuals had slightly longer LOS than older individuals. This was most apparent for pelvic and femur fractures in comparison to the other fracture sites. The longer LOS could be due to traumatic nature of these types of fracture in younger individuals; however, the level of trauma could not be determined from these data.  (Reference Table 4A.3.1 PDF CSV)

Lastly, LOS was significantly longer in non-Hispanic black persons with fractures at all fracture sites compared to the other race and ethnic groups. (Reference Table 4A.3.3 PDF CSV)


Hospitalization, Mean Charges


Hospital charges are based on standard hospital cost for patient stays and procedures and provide a comparison between groups. They are not indicative of actual cost paid by insurance companies and patients. Charges are associated with individual hospital stays with a fracture diagnosis and do not include additional costs associated with the same fracture for any readmission, physician care, or long-term care required.

Overall, in 2014, fragility fractures were associated with nearly $60,000 in mean hospital charges. The highest charges were associated with femur fractures ($75,000), whereas the lowest charges were associated with pelvic fractures ($39,700). Charges were higher in men with fractures than women. (Reference Table 4A.3.1 PDF CSV)

Charges decreased as age increased for all fracture types. The reason for lower hospital charges among the eldest patients is not fully understood but is possibly due to shorter stays, particularly for spine, pelvic and femur fractures, among those age 80 and over where transfer rates to short/long term care is higher. Elderly patients also may not have surgery for fixation. (Reference Table 4A.3.1 PDF CSV)

Overall and by fracture site, Hispanics had the highest hospital charges, followed by non-Hispanic blacks and people from other race and ethnic groups, and then non-Hispanic Whites. (Reference Table 4A.3.3 PDF CSV)



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