The socioeconomic burden of osteoporosis: a cost of illness study in Bulgaria

Abstract Background Little is known about the socioeconomic impact of osteoporosis in Bulgaria. We aimed to estimate the socioeconomic burden of this chronic condition, including direct healthcare costs, direct non-healthcare costs, and productivity losses for both patients and caregivers. Methods We conducted a single-center cost-of-illness study. Adult patients with osteoporosis with pathological fracture, treated and followed at a tertiary referral hospital, were invited to complete a questionnaire. It assessed their use of healthcare services, social support, formal and informal care, and work or productivity limitations. A prevalence-based, bottom-up costing approach was used to estimate the burden from a societal perspective, using 2024 as the reference year. Results Fifty patients participated, with a median age of 64.5 years; 90% were women. The most common diagnosis was postmenopausal osteoporosis with pathological fracture (54.0%). The median annual socioeconomic burden was €5,812.35 per patient, with private costs accounting for half of the total. Productivity losses among patients and caregivers were the main cost drivers, followed by hospitalizations. Higher burden was associated with younger age, need for a caregiver, and comorbidities. Overall, patients reported high satisfaction with the healthcare system and its services. Conclusions This study offers the first real-world data on the socioeconomic burden of osteoporosis in Bulgaria. With private costs making up half of the total, the disease places a significant burden on patients and their families. Key messages • Better coordination between healthcare and social services is essential. • A holistic partnership can ease the burden of chronic conditions like osteoporosis.