A systematic review of the indirect and social costs studies in fragility fractures.

Fragility fractures (FF) are the main clinical consequence of osteoporosis. FF lead to a loss in quality of life (QL), increased dependency and higher costs due to loss of productivity. Despite this, very few studies have been performed about the indirect or social costs of FF. The objective of this review was to systematically synthesize published evidence regarding indirect costs of FF. We conducted a systematic literature review of empirical studies published as peer review papers between 1998 and 2019. A total of 295 papers were found about costs and osteoporosis. After an iterative process, only 16 papers fit the criteria of selection. Despite the important consequences for QL, only seven studies have included research of the issue and only one about dependency. Treatments are cost-effective, but adherence is low. Multiple fractures, older age and low socioeconomic profile imply higher costs. Most studies are performed using the human capital methodology. The main two variables are loss of productivity and absenteeism. Most of the people included in the samples are out of the active population. Those studies that include a follow-up period vary in a range between 3 months and 2 years. Depending on sample and methodology, the indirect costs (IC) are between 2 and 50%. The direct costs associated with FF generally far outweigh the IC. There is a lack of studies about the effects of treatments and adherence and about the dependency system. The changing role of women in coming generations will increase indirect costs.