“Pathologic” fractures: should these be included in epidemiologic studies of osteoporotic fractures?
Purchase on Springer.com
$39.95 / €34.95 / £29.95*
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.
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.
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.
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.
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.
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.
- Burge R, Dawson-Hughes B, Solomon DH, Wong JB, King A, Tosteson A (2007) Incidence and economic burden of osteoporosis-related fractures in the United States, 2005–2025. J Bone Miner Res 22(3):465–475 CrossRef
- Gardner RL, Harris F, Vittinghoff E, Cummings SR (2008) The risk of fracture following hospitalization in older women and men. Arch Intern Med 168(15):1671–1677 CrossRef
- www.merriam-Webster.com, accessed September 25, 2008
- http://www.eicd.com/contact.htm. ICD-9-CM Official Guidelines for Coding and Reporting, effective October 1, 2007; accessed Feb. 22, 2008
- Baron JA, Lu-Yao G, Barrett J, McLerran D, Fisher ES (1994) Internal validation of Medicare claims data. Epidemiology 5(5):541–544
- Ray WA, Griffin MR, Fought RL, Adams ML (1992) Identification of fractures from computerized Medicare files. J Clin Epidemiol 45(7):703–714 CrossRef
- Curtis J, Mudano A, Solomon DH, Xi J, Elkins M, Saag KG (2009) Identification and validation of vertebral compression fractures using administrative claims data. Medical Care 47(1):69–72 CrossRef
- McBean AM, Warren JL, Babish JD (1994) Measuring the incidence of cancer in elderly Americans using Medicare claims data. Cancer 73(9):2417–2425 CrossRef
- Warren JL, Feuer E, Potosky AL, Riley GF, Lynch CF (1999) Use of medicare hospital and physician data to assess breast cancer incidence. Med Care 37(5):445–456 CrossRef
- Whittle J, Steinberg EP, Anderson GF, Herbert R (1991) Accuracy of Medicare claims data for estimation of cancer incidence and resection rates among elderly Americans. Med Care 29(12):1226–1236 CrossRef
- “Pathologic” fractures: should these be included in epidemiologic studies of osteoporotic fractures?
Volume 20, Issue 11 , pp 1969-1972
- Cover Date
- Print ISSN
- Online ISSN
- Additional Links
- Hip fracture
- Pathologic fracture
- Vertebral fracture
- Industry Sectors
- Author Affiliations
- 1. Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, AL, USA
- 6. 510 20th Street South, FOT 840, Birmingham, AL, 35294, USA
- 2. Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA
- 3. Department of Health Services Administration, University of Alabama at Birmingham, Birmingham, AL, USA
- 4. Department of Health Care Organization and Policy, University of Alabama at Birmingham, Birmingham, AL, USA
- 5. Division of Endocrinology, University of Alabama at Birmingham, Birmingham, AL, USA