Clinical and demographic factors associated with fractures among older Americans
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Medicare claims data were used to investigate associations between history of previous fractures, chronic conditions, and demographic characteristics and occurrence of fractures at six anatomic sites. The study confirmed previously established associations for hip and spine fractures and identified several new associations of interest for nonhip, nonspine fractures.
This study investigates the associations of a history of fracture, comorbid chronic conditions, and demographic characteristics with incident fractures among Medicare beneficiaries. The majority of fracture incidence studies have focused on the hip and on white females. This study examines a greater variety of fracture sites and more population subgroups than prior studies.
We used Medicare claims data to examine the incidence of fracture at six anatomic sites in a random 5% sample of Medicare beneficiaries during the time period 2000 through 2005.
For each type of incident fracture, women had a higher rate than men, and there was a positive association with age and an inverse association with income. Whites had a higher rate than nonwhites. Rates were lowest among African-Americans for all sites except ankle and tibia/fibula, which were lowest among Asian-Americans. Rates of hip and spine fracture were highest in the South, and fractures of other sites were highest in the Northeast. Fall-related conditions and depressive illnesses were associated with each type of incident fracture, conditions treated with glucocorticoids with hip and spine fractures and diabetes with ankle and humerus fractures. Histories of hip and spine fractures were associated positively with each site of incident fracture except ankle; histories of nonhip, nonspine fractures were associated with most types of incident fracture.
This study confirmed previously established associations for hip and spine fractures and identified several new associations of interest for nonhip, nonspine fractures.
KeywordsEpidemiology Fractures Incidence Medicare Osteoporosis
Conflicts of interest
This research was supported by a contract between UAB and Amgen, Inc. Only the authors from UAB had access to the Medicare data used. The analysis, presentation, and interpretation of the results were solely the responsibility of the authors. Some of the investigators (JRC, KGS) also receive salary support from the National Institutes of Health (AR053351, AR052361), the Agency for Healthcare Research and Quality (U18 HS016956), and the Arthritis Foundation (JRC). Two investigators received research support from Novartis, Merck, Eli Lilly, Amgen (JRC, KGS), and Procter & Gamble (JRC), in a consulting and/or advisory board role for Procter & Gamble (JRC), Novartis, Merck, Eli Lilly, and Amgen (KGS) and as members of the speakers bureau for Novartis (JRC, KGS) and for Procter & Gamble and Eli Lilly (JRC).
- 25.CDC (1996) Incidence and costs to Medicare of fractures among Medicare beneficiaries aged > or =65 years—United States, July 1991-June 1992. MMWR 45:877–883Google Scholar
- 33.Hinton RY, Lennox DW, Ebert FR, Jacobsen SJ, Smith GS (1995) Relative rates of fracture of the hip in the United States. Geographic, sex, and age variations. Bone Joint Surg Am 77:695–702Google Scholar
- 45.Buccaneer Computer Systems and Services, Inc. Chronic Condition Data Warehouse User Manual; 2008; Available from: http://www.ccwdata.org/downloads/CCW%20User%20Manual.pdf
- 47.Curtis JR, Mudano A, Solomon DH, Kim Y, Saag KG (2007) Identifying clinical vertebral fracture using administrative claims data: a validation study. J Bone Miner Res 22:Abstract M354:S199.Google Scholar
- 49.Rural-Urban Commuting Area Codes. WWAMI Rural Health Research Center. Available from: http://depts.washington.edu/uwruca/
- 50.U.S. Census Bureau Census 2000 Summary File 3 (SF 3)—Sample Data. Available at http://www.census.gov/
- 55.Ismail AA, Cockerill W, Cooper C, Finn JD, Abendroth K, Parisi G, Banzer D, Benevolenskaya LI, Bhalla AK, Armas JB, Cannata JB, Delmas PD (2001) Prevalent vertebral deformity predicts incident hip though not distal forearm fracture: results from the European Prospective Osteoporosis Study. Osteoporos Int 12:85–90PubMedCrossRefGoogle Scholar
- 62.Rolland Y, Abellan van Kan G, Benetos A, Blain H, Bonnefoy M, Chassagne P, Jeandel C, Laroche M, Nourhashemi F, Orcel P, Piette F, Ribot C, Ritz P, Roux C, Taillandier J, Tremollieres F, Weryha G, Vellas B (2008) Frailty, osteoporosis and hip fracture: causes, consequences and therapeutic perspectives. J Nutr Health Aging 12:335–346PubMedCrossRefGoogle Scholar
- 74.Weinstein JN, Birkmeyer JD (eds) (2000) The Dartmouth Atlas of Musculoskeletal Health Care. American Hospital Publishing, Chicago, ILGoogle Scholar
- 75.Finkelstein JS, Lee ML, Sowers M, Ettinger B, Neer RM, Kelsey JL, Cauley JA, Huang MH, Greendale GA (2002) Ethnic variation in bone density in premenopausal and early perimenopausal women: effects of anthropometric and lifestyle factors. J Clin Endocrinol Metab 87:3057–3067PubMedCrossRefGoogle Scholar
- 77.International Osteoporosis Foundation, Fixed risk factors. Available from: http://www.iofbonehealth.org