4 59,015 41,474 17,541 (16,803, 18,218) 73.7 63,159 42,895 20,263(18,163, 22,577)  Community baseline—survived year 1b 94.8 BIBW2992 chemical structure 53,386 8,139 45,247 (44,548,

45,955) 93.9 56,750 8,184 48,566 (47,118, 50,174) Second hip fracture  Second hip fracture in year 1 (cost year 1) NA 85,614 14,992 70,621 (65,777, 76,063) NA 87,726 14,088 73,638 (60,853, 86,245)  Second hip fracture in year 2 (cost year 2) NA 52,912 13,018 39,895 (36,459, 43,374) NA 63,939 11,481 52,458 (44,611, 60,923) Survival statusb  Survived year 1 (cost year 1) 96.3 54,218 13,069 41,149 (40,489, 41,774) 91.4 57,390 11,648 45,742 (44,257, 47,098)  Survived year 1 (cost year 2) 96.3 22,983 selleck products 13,966 9,017 (8,578, 9,471) 91.4 22,909 12,563 10,347 (9,417, 11,275)  Survived year 2 (cost year

2) 80.1 22,019 12,467 9,552 (9,141, 10,004) 71.7 21,032 10,524 10,507 (9,514, 11,451)  Died year 1 (cost year 1) 13.8 34,873 23,938 10,935 (8,347, 13,364) 15.2 40,216 25,765 14,451 (10,062, 18,826)  Died year 2 (cost year 2) 10.5 23,696 23,470 226 (−4,297, 4,939) 11.2 26,806 26,336 469 (−5,073, 6,383)  Died year 2 (cost year 1) 10.5 70,601 32,134 38,466 (36,376, 39,487) 11.2 72,568 26,336 46,232 (38,285, 47,503) Selleckchem ASP2215 attributable mean cost hip fracture cohort − mean cost non-hip fracture cohort, CI confidence interval, LTC long-term care, NA not applicable aPercentage of hip fracture patients with a matched concordant pair bCalculated only among concordant pairs who both survived or died in the given year Lck Across the four fiscal years evaluated, the total cumulative first year attributable cost of hip fractures in Ontario was estimated at $282.1 million (females = $206.9

million, males = $75.1 million). The total cumulative attributable cost in the second year was $64.5 million in Ontario. Discussion Our results emphasize the major health and economic burden of hip fractures on the Canadian health-care system. The 1 year direct attributable health-care system cost of hip fracture was $282.1 million in Ontario, with survivors costing an additional $64.5 million in the second year post-fracture. Based on these estimates and reports that indicate approximately 30,000 hip fractures annually in Canada [4, 25], the direct attributable health-care cost of hip fracture is approximately $1.1 billion per year in Canada. Three prior studies have evaluated the longitudinal cost of hip fractures from a Canadian perspective [5–7].