Short Communication

Osteoporosis International

, Volume 20, Issue 11, pp 1969-1972

“Pathologic” fractures: should these be included in epidemiologic studies of osteoporotic fractures?

  • J. R. CurtisAffiliated withDivision of Clinical Immunology and Rheumatology, University of Alabama at Birmingham Email author 
  • , A. J. TaylorAffiliated withDepartment of Epidemiology, University of Alabama at Birmingham
  • , R. S. MatthewsAffiliated withDepartment of Epidemiology, University of Alabama at Birmingham
  • , M. N. RayAffiliated withDepartment of Health Services Administration, University of Alabama at Birmingham
  • , D. J. BeckerAffiliated withDepartment of Health Care Organization and Policy, University of Alabama at Birmingham
  • , L. C. GaryAffiliated withDepartment of Health Care Organization and Policy, University of Alabama at Birmingham
  • , M. L. KilgoreAffiliated withDepartment of Health Care Organization and Policy, University of Alabama at Birmingham
  • , M. A. MorriseyAffiliated withDepartment of Health Care Organization and Policy, University of Alabama at Birmingham
  • , K. G. SaagAffiliated withDivision of Clinical Immunology and Rheumatology, University of Alabama at BirminghamDepartment of Epidemiology, University of Alabama at Birmingham
    • , A. WarrinerAffiliated withDivision of Endocrinology, University of Alabama at Birmingham
    • , E. DelzellAffiliated withDepartment of Epidemiology, University of Alabama at Birmingham

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Abstract

Summary

Pathologic fractures are often excluded in epidemiologic studies of osteoporosis. Using Medicare administrative data, we identified persons with vertebral and hip fractures. Among these, 48% (vertebral) and 3% (hip) of the fractures were coded as pathologic. Only 25% and 66% of persons with these pathologic fractures had evidence for malignancy.

Introduction

Analyses of osteoporosis-related fractures that use administrative data often exclude pathologic fractures (ICD-9 733.1x) due to concern that these are caused by cancer. We examined “pathologic” fractures of the vertebrae and hip to evaluate their contribution to fracture incidence and assessed the evidence for a malignancy.

Methods

We studied US Medicare beneficiaries age ≥65 with new fractures identified using ICD-9 diagnosis codes 733.13 (pathologic vert), 805.0, 805.2, 805.4, 805.8 (nonpathologic vert); and 733.14 (pathologic hip), 820.0, 820.2, 820.8 (nonpathologic hip). We further examined the proportion of cases with a diagnosis of a malignancy proximate to the fracture.

Results

We identified 44,120 individuals with a vertebral fracture and 60,354 with a hip fracture. Approximately 48% of vertebral fractures and 3% of hip fractures were coded as pathologic. For only approximately 25% of persons with a “pathologic” vertebral fracture ICD-9 code, but 66% of persons with a “pathologic” hip fracture, there was evidence of a possible cancer diagnosis.

Conclusion

Among US Medicare beneficiaries, one fourth of pathologic vertebral fracture and two thirds of pathologic hip fracture cases had evidence for a malignancy. Particularly for vertebral fractures, excluding persons with pathologic fractures in epidemiologic analyses that utilize administrative claims data substantially underestimates the burden of fractures due to osteoporosis.

Keywords

Epidemiology Hip fracture Pathologic fracture Vertebral fracture