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Direct costs of osteoporosis-related hip fractures: protocol for a cross-sectional analysis of a national database
  1. Zhila Maghbooli1,
  2. Arash Hossein-nezhad2,
  3. Maryam Jafarpour3,
  4. Sima Noursaadat3,
  5. Majid Ramezani1,
  6. Roxana Hashemian4,
  7. Syamak Moattari5
  1. 1 Endocrinology and Metabolism Research Institute of Tehran University of Medical Sciences, Tehran, Iran
  2. 2 Department of Medicine, Section of Endocrinology, Nutrition, and Diabetes, Vitamin D, Skin and Bone Research Laboratory, Boston University Medical Campus, Boston, Massachusetts, USA
  3. 3 Statistics and Information Technology, Ministry of Health and Medical Education, Tehran, Iran
  4. 4 Boston University School of Dental Medicine, Boston, Massachusetts, USA
  5. 5 Department of Health Sciences, Worcester State University, Worcester, Massachusetts, USA
  1. Correspondence to Dr Arash Hossein-nezhad; arash_hsi{at}


Introduction It is estimated that Iran accounted for about 1% of hip fracture burden of the world in 2007, but these data are based on incomplete evidence. As the country’s population is ageing, it is expected that a dramatic rise in hip fracture incidence will result. There is no single national study that accurately estimates the incidence of all hip fractures in the country or identifies the direct costs for affected patients. To help fill this gap, the current study has been designed to determine the incidence of hip fracture associated with osteoporosis in the Iranian population and to assess the direct costs involved.

Methods and analysis This is a cross-sectional analysis of 2 years of hospital admissions due to hip fracture in Iran from October 2014 to October 2016 using an electronic health record called SEPAS. SEPAS is a nationwide health information system established by Information Technology (IT) and the Statistics Department of the Ministry of Health. SEPAS has recorded more than 8.5 million inpatient hospitalizations since October 2014. Our study will identify reported hip fracture data in SEPAS among admitted adult hospital patients aged ≥50 in Iran. International Classification of Diseases ICD-9 and 10 will be used as diagnostic codes. Study factors are demographic data, types of fracture, types of treatment, duration of admission, early complications, in-hospital mortality and direct cost of fracture treatment. The accuracy of the SEPAS fracture data will be ascertained through a pilot study that compares the SEPAS data with the data directly extracted from medical records of the Shariati Hospital in Tehran during the study period.

Ethics and dissemination The study protocol was approved by the Ethics Committee of the National Institute for Medical Research Development of Iran. Dissemination plans include academic publications, conference presentations and social media.

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  • Contributors ZM, AH and MR conceived the study design. ZM, AH, SN, MJ, MR, RH and SM contributed to the design of data collection tools and wrote the statistical analysis plan. ZM, AH, SN and MJ monitor the data collection and analysis of the data for the whole trial. ZM, AH, RH and SM drafted the manuscript, and all authors reviewed and revised the protocol. All authors approved the final protocol to be published.

  • Funding This work is supported by the National Institute for Medical Research Development of Iran (grant number IR.NIMAD.REC.940204).

  • Competing interests None declared.

  • Ethics approval The study protocol was approved by the Ethics Committee of the National Institute for Medical Research Development (NIMAD) of Iran.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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