The incremental risk of fragility fractures in aging men

Abstract

Introduction

While the United States Preventative Services Task Force recommends osteoporosis screening for women 65 years and older, there is no definitive recommendation for routine osteoporosis screening in men. The purpose of this study was to determine the age at which the odds of fragility fractures (FFx) increase in men to help guide future policy discussions evaluating an optimal screening strategy in this population.

Methods

Men older than 49 years were identified in the PearlDiver Patient Records Database. Patients were excluded if they had a prior fragility fracture, if they were at high risk for osteoporosis due to comorbidities, or if they carried a diagnosis of and/or were on treatment for osteoporosis. The prevalence of FFx was trended for each age group. A stratum-specific likelihood ratio (SSLR) analysis was conducted to identify data-driven strata that maximize the incremental FFx risk by age for men. Logistic regression analyses controlling for potential confounders were conducted to test these identified strata.

Results

The incidence of FFx started to increase after the age of 64 years for men. Further, the identified data-driven age strata associated with a significant and incremental difference in fragility fractures were the following: 50–64, 65–69, 70–72, 73–75, 76–78, 79–80, and 81+. When compared to the youngest age stratum (50–64 years), multivariable regression showed the risk of fragility fracture incrementally increased starting in those aged 70–72 (RR, 1.31; 95% CI. 1.21–1.46; p < 0.001) with the highest risk in those aged 81+ (RR, 5.35; 95% CI, 5.10–5.62; p < 0.001).

Conclusion

In men without a pre-existing history of osteoporosis, the risk of fragility fractures starts to increase after the age of 70. Further work building upon these data may help to identify a specific age at which routine bone health screening in males can help to minimize fractures and their associated morbidity and mortality.

Appendix

Category	ICD or CPT billing code
routine primary care/family physician visit	CPT-99386, CPT-99387, CPT-99397, CPT-Z0000, CPT-Z0001
Fragility fractures (Fragility when excluding traumatic injury)
Spine fracture	ICD-9-D-80500, ICD-9-D-80501, ICD-9-D-80502, ICD-9-D-80503, ICD-9-D-80504, ICD-9-D-80505, ICD9-D-80506, ICD-9-D-80507, ICD-9-D-8052, ICD-9-D-8054, ICD-9-D-8058, ICD-9-D-8060, ICD-9-D80600:ICD-9-D-80609, ICD-9-D-80620:ICD-9-D-80629, ICD-9-D-8064, ICD-9-D-8068, ICD-9-D-73313, ICD-10-D-S129XXA, ICD-10-D-S12000A, ICD-10-D-S12001A, ICD-10-D-S12100A, ICD-10-DS12101A, ICD-10-D-S12200A, ICD-10-D-S12201A, ICD-10-D-S12300A, ICD-10-D-S12301A, ICD10-D-S12400A, ICD-10-D-S12401A, ICD-10-D-S12500A, ICD-10-D-S12501A, ICD-10-D-S12600A, ICD-10-D-S12601A, ICD-10-D-S22009A, ICD-10-D-S32009A, ICD-10-D-S3210XA, ICD-10-DS322XXA, ICD-10-D-S14101A, ICD-10-D-S14102A, ICD-10-D-S14103A, ICD-10-D-S14104A, ICD10-D-S14111A, ICD-10-D-S14112A, ICD-10-D-S14113A, ICD-10-D-S14114A, ICD-10-D-S14121A, ICD-10-D-S14122A, ICD-10-D-S14123A, ICD-10-D-S14124A, ICD-10-D-S14131A, ICD-10-DS14132A, ICD-10-D-S14133A, ICD-10-D-S14134A, ICD-10-D-S14151A, ICD-10-D-S14152A, ICD10-D-S14153A, ICD-10-D-S14154A, ICD-10-D-S14105A, ICD-10-D-S14106A, ICD-10-D-S14107A, ICD-10-D-S14115A, ICD-10-D-S14116A, ICD-10-D-S14117A, ICD-10-D-S14125A, ICD-10-DS14126A, ICD-10-D-S14127A, ICD-10-D-S14135A, ICD-10-D-S14136A, ICD-10-D-S14137A, ICD-10- D-S14155A, ICD-10-D-S14156A, ICD-10-D-S14157A, ICD-10-D-S24101A, ICD-10-D-S24102A, ICD10-D-S24111A, ICD-10-D-S24112A, ICD-10-D-S24131A, ICD-10-D-S24132A, ICD-10-D-S24151A, ICD-10-D-S24152A, ICD-10-D-S24103A, ICD-10-D-S24104A, ICD-10-D-S24113A, ICD-10-DS24114A, ICD-10-D-S24133A, ICD-10-D-S24134A, ICD-10-D-S24153A, ICD-10-D-S24154A, ICD-10- D-S34109A, ICD-10-D-S34119A, ICD-10-D-S34129A, ICD-10-D-S32009A, ICD-10-D-S34101A, ICD10-D-S34111A, ICD-10-D-S34121A, ICD-10-D-S32019A, ICD-10-D-S34102A, ICD-10-D-S34112A, ICD-10-D-S34122A, ICD-10-D-S32029A, ICD-10-D-S34103A, ICD-10-D-S34113A, ICD-10-DS34123A, ICD-10-D-S32039A, ICD-10-D-S34104A, ICD-10-D-S34114A, ICD-10-D-S34124A, ICD-10- D-S32049A, ICD-10-D-S34105A, ICD-10-D-S34115A, ICD-10-D-S34125A, ICD-10-D-S32059A, ICD10-D-S14109A, ICD-10-D-S24109A, ICD-10-D-S34109A, ICD-10-D-S34139A, ICD-10-D-M4850XA, ICD-10-D-M8008XA, ICD-10-D-M8448XA, ICD-10-D-M8468XA, ICD-9-D-73313, ICD-9-D-73315, ICD-10-D-M8008XA, ICD-10-D-M8088XA
Hip fracture	ICD-9-D-82000:ICD-9-D-82009, ICD-9-D-82020:ICD-9-D-82022, ICD-9-D-8208, ICD-9-D-73314, ICD10-D-S72001A, ICD-10-D-S72002A, ICD-10-D-S72009A, ICD-10-D-S72011A, ICD-10-D-S72012A, ICD-10-D-S72019A, ICD-10-D-S72021A, ICD-10-D-S72022A, ICD-10-D-S72023A, ICD-10-DS72031A, ICD-10-D-S72032A, ICD-10-D-S72033A, ICD-10-D-S72041A, ICD-10-D-S72042A, ICD-10- D-S72043A, ICD-10-D-S72091A, ICD-10-D-S72092A, ICD-10-D-S72099A, ICD-10-D-S72101A, ICD10-D-S72102A, ICD-10-D-S72109A, ICD-10-D-S72141A, ICD-10-D-S72142A, ICD-10-D-S72143A, ICD-10-D-S72231A, ICD-10-D-S72232A, ICD-10-D-S7223XA, ICD-10-D-M84451A, ICD-10-DM84452A, ICD-10-D-M84453A, ICD-10-D-M84459A, ICD-9-D-73314, ICD-10-D-M80051A, ICD-10- D-M80052A, ICD-10-D-M80059A, ICD-10-D-M80851A, ICD-10-D-M80852A, ICD-10-D-M80859A
Pelvic fracture	ICD-9-D-8080, ICD-9-D-8082, ICD-9-D-80841, ICD-9-D-80842, ICD-9-D-80849, ICD-9-D-8088, ICD10-D-S32401A, ICD-10-D-S32402A, ICD-10-D-S32409A, ICD-10-D-S32501A, ICD-10-D-S32502A, ICD-10-D-S32501A, ICD-10-D-S32502A, ICD-10-D-S32509A, ICD-10-D-S32301A, ICD-10-DS32302A, ICD-10-D-S32309A, ICD-10-D-S32601A, ICD-10-D-S32602A, ICD-10-D-S32609A, ICD10-D-S32810A, ICD-10-D-S32811A, ICD-10-D-S3282XA, ICD-10-D-S3289XA, ICD-10-D-S329XXA, ICD-10-D-M84454A
Wrist fracture	ICD-9-D-81340:ICD-9-D-81347, ICD-9-D-73312, ICD-10-D-S5290XA, ICD-10-D-S52531A, ICD-10-DS52532A, ICD-10-D-S52539A, ICD-10-D-S52541A, ICD-10-D-S52542A, ICD-10-D-S52549A, ICD10-D-S52501A, ICD-10-D-S52502A, ICD-10-D-S52509A, ICD-10-D-S52601A, ICD-10-D-S52602A, ICD-10-D-S52609A, ICD-10-D-S52111A, ICD-10-D-S52112A, ICD-10-D-S52119A, ICD-10-DS52521A, ICD-10-D-S52522A, ICD-10-D-S52529A, ICD-10-D-S52011A, ICD-10-D-S52012A, ICD-10- D-S52019A, ICD-10-D-S52621A, ICD-10-D-S52622A, ICD-10-D-S52629A, ICD-10-D-S52011A, ICD10-D-S52012A, ICD-10-D-S52019A, ICD-10-D-S52621A, ICD-10-D-A52622A, ICD-10-D-S52629A, ICD-10-D-M84431A, ICD-10-D-M84432A, ICD-10-D-M84439A, ICD-9-D-73312, ICD-10-D-M80031A, ICD-10-D-M80032A, ICD-10-D-M80039A, ICD-10-D-M80831A, ICD-10-D-M80832A, ICD-10-DM80839A
Humerus fracture	ICD-9-D-81200:ICD-9-D-81209, ICD-9-D-81220, ICD-9-D-81221, ICD-9-D-81240:ICD-9-D-81249, ICD9-D-73311, ICD-10-D-S42201A, ICD-10-D-S42202A, ICD-10-D-S42209A, ICD-10-D-S42211A, ICD10-D-S42212A, ICD-10-D-S42213A, ICD-10-D-S42214A, ICD-10-D-S42215A, ICD-10-D-S42216A, ICD-10-D-S42291A, ICD-10-D-S42292A, ICD-10-D-S42293A, ICD-10-D-S42294A, ICD-10-DS42295A, ICD-10-D-S42296A, ICD-10-D-S42251A, ICD-10-D-S42252A, ICD-10-D-S42253A, ICD10-D-S42254A, ICD-10-D-S42255A, ICD-10-D-S42256A, ICD-10-D-S42291A, ICD-10-D-S42292A, ICD-10-D-S42293A, ICD-10-D-S42294A, ICD-10-D-S42295A, ICD-10-D-S42296A, ICD-10-DS42301A, ICD-10-D-S42302A, ICD-10-D-S42309A, ICD-10-D-S42391A, ICD-10-D-S42392A, ICD-10- D-S42399A, ICD-10-D-S42401A, ICD-10-D-S42402A, ICD-10-D-S42409A, ICD-10-D-S42411A, ICD10-D-S42412A, ICD-10-D-S42413A, ICD-10-D-S42414A, ICD-10-D-S42415,A ICD-10-D-S42416A, ICD-10-D-S42431A, ICD-10-D-S42432A, ICD-10-D-S42433A, ICD-10-D-S42434A, ICD-10-DS42435A, ICD-10-D-S42436A, ICD-10-D-S42451A, ICD-10-D-S42452A, ICD-10-D-S42453A, ICD-10- D-S42454A, ICD-10-D-S42455A, ICD-10-D-S42456A, ICD-10-D-S42441A, ICD-10-D-S42442A, ICD10-D-S42443A, ICD-10-D-S42444A, ICD-10-D-S42445A, ICD-10-D-S42446A, ICD-10-D-S42461A, ICD-10-D-S42462A, ICD-10-D-S42463A, ICD-10-D-S42464A, ICD-10-D-S42465A, ICD-10-DS42466A, ICD-10-D-S42471A, ICD-10-D-S42472A, ICD-10-D-S42473A, ICD-10-D-S42474A, ICD-10- D-S42475A, ICD-10-D-S42476A, ICD-10-D-S42491A, ICD-10-D-S42492A, ICD-10-D-S42493A, ICD10-D-S42494A, ICD-10-D-S42495A, ICD-10-D-S42496A, ICD-10-D-M84421A, ICD-10-D-M84422A, ICD-10-D-M84429A, ICD-9-D-73311, ICD-10-D-M80011A, ICD-10-D-M80012A, ICD-10-D-M80019A, ICD-10-D-M80021A, ICD-10-D-M80022A, ICD-10-D-M80029A, ICD-10-D-M80811A, ICD-10-DM80812A, ICD-10-D-M80819A, ICD-10-D-M80821A, ICD-10-D-M80822A, ICD-10-D-M80829A
Other fracture	ICD-9-D-73310, ICD-9-D-73316, ICD-9-D-73319, ICD-10-D-M8000XA, ICD-10-D-M80041A, ICD-10- D-M80042A, ICD-10-D-M80049A, ICD-10-D-M80061A, ICD-10-D-M80062A, ICD-10-D-M80069A, ICD-10-D-M80071A, ICD-10-D-M80072A, ICD-10-D-M80079A, ICD-10-D-M8080XA, ICD-10-DM80841A, ICD-10-D-M80842A, ICD-10-D-M80849A, ICD-10-D-M80861A, ICD-10-D-M80862A, ICD10-D-M80869A, ICD-10-D-M80871A, ICD-10-D-M80872A, ICD-10-D-M80879A
Traumatic injury	ICD-9-D-E8120, ICD-9-D-E8121, ICD-9-D-E8199, ICD-9-D-E8190, ICD-9-D-E8160, ICD-9-DE8129, ICD-9-D-E8191, ICD-9-D-E8147, ICD-9-D-E8150, ICD-9-D-E8130, ICD-9-D-E8210, ICD-9-D-E8161, ICD-9-D-E8192, ICD-9-D-E8162, ICD-9-D-E8131, ICD-9-D-E8122, ICD-9-DE8219, ICD-9-D-E8151, ICD-9-D-E8136, ICD-9-D-E8181, ICD-9-D-E8189, ICD-9-D-E8197, ICD-9-D-E8259, ICD-9-D-E8212, ICD-9-D-E8180, ICD-9-D-E8250, ICD-9-D-E8171, ICD-9-DE8182, ICD-9-D-E8179, ICD-9-D-E8249, ICD-9-D-E8230, ICD-9-D-E8211, ICD-9-D-E8241, ICD-9-D-E8139, ICD-9-D-E8252, ICD-9-D-E8127, ICD-9-D-E8149, ICD-9-D-E8128, ICD-9-DE8152, ICD-9-D-E8198, ICD-9-D-E8251, ICD-9-D-E8169, ICD-9-D-E9885, ICD-9-D-E8187, ICD-9-D-E8159, ICD-9-D-E8257, ICD-9-D-E8146, ICD-9-D-E8132, ICD-9-D-E8123, ICD-9-DE8110, ICD-9-D-E8240, ICD-9-D-E8170, ICD-9-D-E8126, ICD-9-D-E8188, ICD-9-D-E8196, ICD-9-D-E8200, ICD-9-D-E8193, ICD-9-D-E8258, ICD-9-D-E8218, ICD-9-D-E8231, ICD-9-DE8220, ICD-9-D-E8158, ICD-9-D-E8163, ICD-9-D-E8227, ICD-9-D-E8111, ICD-9-D-E8209, ICD-9-D-E8140, ICD-9-D-E8248, ICD-9-D-E8217, ICD-9-D-E8138, ICD-9-D-E8183, ICD-9-DE8232, ICD-9-D-E8682, ICD-9-D-E8100, ICD-9-D-E8178, ICD-9-D-E8137, ICD-9-D-E8148, ICD-9-D-E8239, ICD-9-D-E8221, ICD-9-D-E8141, ICD-9-D-E8242, ICD-9-D-E8186, ICD-9-DE8229, ICD-9-D-E8237, ICD-9-D-E8172, ICD-9-D-E8119, ICD-9-D-E8133, ICD-9-D-E8216, ICD-9-D-E8124, ICD-9-D-E8177, ICD-9-D-E8213, ICD-9-D-E8168, ICD-9-D-E8101, ICD-9-DE8208, ICD-9-D-E8153, ICD-9-D-E8157, ICD-9-D-E8194, ICD-9-D-E8222, ICD-9-D-E8134, ICD-9-D-E8167, ICD-9-D-E8226, ICD-9-D-E8142, ICD-9-D-E8201, ICD-9-D-E8166, ICD-9-DE8109, ICD-9-D-E8154, ICD-9-D-E8174, ICD-9-D-E8256, ICD-9-D-E8156, ICD-9-D-E8238, ICD-9-D-E8253, ICD-9-D-E8143, ICD-9-D-E8228, ICD-9-D-E8195, ICD-9-D-E9820, ICD-9-DE8173, ICD-9-D-E8184, ICD-9-D-E8164, ICD-9-D-E8202, ICD-9-D-E8243, ICD-9-D-E8247, ICD-9-D-E8112, ICD-9-D-E8203, ICD-9-D-E8236, ICD-9-D-E8102, ICD-9-D-E8107, ICD-9-DE8103, ICD-9-D-E8104, ICD-9-D-E8106, ICD-9-D-E8108, ICD-9-D-E8113, ICD-9-D-E8114, ICD-9-D-E8115, ICD-9-D-E8118, ICD-9-D-E8125, ICD-9-D-E8135, ICD-9-D-E8144, ICD-9-DE8145, ICD-9-D-E8155, ICD-9-D-E8175, ICD-9-D-E8176, ICD-9-D-E8185, ICD-9-D-E8204, ICD-9-D-E8205, ICD-9-D-E8206, ICD-9-D-E8207, ICD-9-D-E8214, ICD-9-D-E8215, ICD-9-DE8223, ICD-9-D-E8224, ICD-9-D-E8225, ICD-9-D-E8233, ICD-9-D-E8234, ICD-9-D-E8244, ICD-9-D-E8245, ICD-9-D-E8246, ICD-9-D-E8254, ICD-9-D-E8255, ICD-9-D-E9871, ICD-9-DE8849, ICD-9-D-E8810, ICD-9-D-E8801, ICD-9-D-E882, ICD-9-D-E8850, ICD-9-D-E8839, ICD-9-D-E8853, ICD-9-D-E8854, ICD-9-D-E9879, ICD-9-D-E8800, ICD-9-D-E8811, ICD-9-DE8342, ICD-9-D-E8841, ICD-9-D-E8351, ICD-9-D-E8832, ICD-9-D-E8359, ICD-9-D-E8343, ICD-9-D-E8353, ICD-9-D-E8349, ICD-9-D-E8354, ICD-9-D-E8439, ICD-9-D-E8831, ICD-9-DE8339, ICD-9-D-E8041, ICD-9-D-E8341, ICD-9-D-E8348, ICD-9-D-E8260, ICD-9-D-E8261, ICD-9-D-E8262, ICD-9-D-E8263, ICD-9-D-E8264, ICD-9-D-E8268, ICD-9-D-E8269, ICD-9-DE8290, ICD-9-D-E8294, ICD-9-D-E8298, ICD-9-D-E8299, ICD-10-D-V0200XA, ICD-10-D-V0209XA, ICD-10-D-V0210XA, ICD-10-D-V0212XA, ICD-10-D-V0219XA, ICD-10-D-V0290XA, ICD-10-D-V0299XA, ICD-10-D-V0600XA, ICD-10-D-V0609XA, ICD-10-D-V0610XA, ICD-10-D-V0612XA, ICD-10-D-V0619XA, ICD-10-D-V0690XA, ICD-10-D-V0692XA, ICD-10-D-V0699XA, ICD-10-D-V0900XA, ICD-10-D-V0909XA, ICD-10-D-V0920XA, ICD-10-D-V0929XA, ICD-10-D-V120XXA, ICD-10-D-V121XXA, ICD-10-D-V122XXA, ICD-10-D-V123XXA, ICD-10-D-V124XXA, ICD-10-D-V125XXA, ICD-10-D-V129XXA, ICD-10-D-V160XXA, ICD-10-D-V162XXA, ICD-10-D-V163XXA, ICD-10-D-V164XXA, ICD-10-D-V169XXA, ICD-10-D-V1900XA, ICD-10-D-V1909XA, ICD-10-D-V1910XA, ICD-10-D-V1919XA, ICD-10-D-V1920XA, ICD-10-D-V1929XA, ICD-10-D-V1940XA, ICD-10-D-V1949XA, ICD-10-D-V1950XA, ICD-10-D-V1959XA, ICD-10-D-V1960XA, ICD-10-D-V1969XA, ICD-10-D-V220XXA, ICD-10-D-V221XXA, ICD-10-D-V222XXA, ICD-10-D-V223XXA, ICD-10-D-V224XXA, ICD-10-D-V225XXA, ICD-10-D-V229XXA, ICD-10-D-V240XXA, ICD-10-D-V241XXA, ICD-10-D-V244XXA, ICD-10-D-V245XXA, ICD-10-D-V249XXA, ICD-10-D-V250XXA, ICD-10-D-V254XXA, ICD-10-D-V255XXA, ICD-10-D-V259XXA, ICD-10-D-V260XXA, ICD-10-D-V261XXA, ICD-10-D-V262XXA, ICD-10-D-V263XXA, ICD-10-D-V264XXA, ICD-10-D-V265XXA, ICD-10-D-V269XXA, ICD-10-D-V2900XA, ICD-10-D-V2909XA, ICD-10-D-V2910XA, ICD-10-D-V2919XA, ICD-10-D-V2920XA, ICD-10-D-V2929XA, ICD-10-D-V2940XA, ICD-10-D-V2949XA, ICD-10-D-V2950XA, ICD-10-D-V2959XA, ICD-10-D-V2960XA, ICD-10-D-V2969XA, ICD-10-D-V2981XA, ICD-10-D-V300XXA, ICD-10-D-V302XXA, ICD-10-D-V306XXA, ICD-10-D-V307XXA, ICD-10-D-V309XXA, ICD-10-D-V310XXA, ICD-10-D-V315XXA, ICD-10-D-V320XXA, ICD-10-D-V321XXA, ICD-10-D-V322XXA, ICD-10-D-V325XXA, ICD-10-D-V326XXA, ICD-10-D-V327XXA, ICD-10-D-V329XXA, ICD-10-D-V330XXA, ICD-10-D-V331XXA, ICD-10-D-V335XXA, ICD-10-D-V336XXA, ICD-10-D-V339XXA, ICD-10-D-V342XXA, ICD-10-D-V343XXA, ICD-10-D-V346XXA, ICD-10-D-V349XXA, ICD-10-D-V353XXA, ICD-10-D-V356XXA, ICD-10-D-V360XXA, ICD-10-D-V361XXA, ICD-10-D-V363XXA, ICD-10-D-V365XXA, ICD-10-D-V366XXA, ICD-10-D-V369XXA, ICD-10-D-V370XXA, ICD-10-D-V371XXA, ICD-10-D-V373XXA, ICD-10-D-V375XXA, ICD-10-D-V376XXA, ICD-10-D-V377XXA, ICD-10-D-V379XXA, ICD-10-D-V380XXA, ICD-10-D-V381XXA, ICD-10-D-V383XXA, ICD-10-D-V384XXA, ICD-10-D-V385XXA, ICD-10-D-V386XXA, ICD-10-D-V389XXA, ICD-10-D-V3900XA, ICD-10-D-V3919XA, ICD-10-D-V3920XA, ICD-10-D-V393XXA, ICD-10-D-V3940XA, ICD-10-D-V3949XA, ICD-10-D-V3959XA, ICD-10-D-V3960XA, ICD-10-D-V3969XA, ICD-10-D-V3981XA, ICD-10-D-V3989XA, ICD-10-D-V399XXA, ICD-10-D-V420XXA, ICD-10-D-V421XXA, ICD-10-D-V422XXA, ICD-10-D-V424XXA, ICD-10-D-V425XXA, ICD-10-D-V426XXA, ICD-10-D-V427XXA, ICD-10-D-V429XXA, ICD-10-D-V460XXA, ICD-10-D-V461XXA, ICD-10-D-V462XXA, ICD-10-D-V463XXA, ICD-10-D-V464XXA, ICD-10-D-V465XXA, ICD-10-D-V466XXA, ICD-10-D-V467XXA, ICD-10-D-V469XXA, ICD-10-D-V4900XA, ICD-10-D-V4909XA, ICD-10-D-V4910XA, ICD-10-D-V4919XA, ICD-10-D-V4920XA, ICD-10-D-V4929XA, ICD-10-D-V4940XA, ICD-10-D-V4949XA, ICD-10-D-V4950XA, ICD-10-D-V4959XA, ICD-10-D-V4960XA, ICD-10-D-V4969XA, ICD-10-D-V525XXA, ICD-10-D-V526XXA, ICD-10-D-V529XXA, ICD-10-D-V561XXA, ICD-10-D-V564XXA, ICD-10-D-V565XXA, ICD-10-D-V566XXA, ICD-10-D-V567XXA, ICD-10-D-V569XXA, ICD-10-D-V5900XA, ICD-10-D-V5909XA, ICD-10-D-V5910XA, ICD-10-D-V5919XA, ICD-10-D-V5920XA, ICD-10-D-V5929XA, ICD-10-D-V5940XA, ICD-10-D-V5949XA, ICD-10-D-V5950XA, ICD-10-D-V5959XA, ICD-10-D-V5960XA, ICD-10-D-V5969XA, ICD-10-D-V621XXA, ICD-10-D-V624XXA, ICD-10-D-V629XXA, ICD-10-D-V665XXA, ICD-10-D-V666XXA, ICD-10-D-V667XXA, ICD-10-D-V6900XA, ICD-10-D-V6909XA, ICD-10-D-V6910XA, ICD-10-D-V6920XA, ICD-10-D-V6940XA, ICD-10-D-V6949XA, ICD-10-D-V6950XA, ICD-10-D-V6959XA, ICD-10-D-V6960XA, ICD-10-D-V721XXA, ICD-10-D-V722XXA, ICD-10-D-V723XXA, ICD-10-D-V724XXA, ICD-10-D-V726XXA, ICD-10-D-V760XXA, ICD-10-D-V761XXA, ICD-10-D-V762XXA, ICD-10-D-V763XXA, ICD-10-D-V764XXA, ICD-10-D-V765XXA, ICD-10-D-V766XXA, ICD-10-D-V769XXA, ICD-10-D-V7900XA, ICD-10-D-V7909XA, ICD-10-D-V7910XA, ICD-10-D-V7919XA, ICD-10-D-V7920XA, ICD-10-D-V7940XA, ICD-10-D-V7949XA, ICD-10-D-V7950XA, ICD-10-D-V7959XA, ICD-10-D-V7960XA, ICD-10-D-V7969XA, ICD-10-D-V8051XA, ICD-10-D-V8052XA, ICD-10-D-V80790A, ICD-10-D-V810XXA, ICD-10-D-V811XXA, ICD-10-D-V820XXA, ICD-10-D-V821XXA, ICD-10-D-V8609XA, ICD-10-D-V8619XA, ICD-10-D-V8629XA, ICD-10-D-V8639XA, ICD-10-D-V8649XA, ICD-10-D-V8659XA, ICD-10-D-V8669XA, ICD-10-D-V8679XA, ICD-10-D-V8699XA, ICD-10-D-V871XXA, ICD-10-D-V877XXA, ICD-10-D-V878XXA, ICD-10-D-V879XXA, ICD-10-D-V880XXA, ICD-10-D-V881XXA, ICD-10-D-V887XXA, ICD-10-D-V888XXA, ICD-10-D-V889XXA, ICD-10-D-V890XXA, ICD-10-D-V891XXA, ICD-10-D-V892XXA, ICD-10-D-V893XXA, ICD-10-D-X810XXA, ICD-10-D-X820XXA, ICD-10-D-X822XXA, ICD-10-D-X828XXA, ICD-10-D-Y020XXA, ICD-10-D-Y030XXA, ICD-10-D-Y038XXA, ICD-10-D-Y32XXXA, ICD-10-D-W002XXA, ICD-10-D-W1789XA, ICD-10-D-W1843XA, ICD-10-D-W109XXA, ICD-10-D-W11XXXA, ICD-10-D-W009XXA, ICD-10-D-W1781XA, ICD-10-D-W14XXXA, ICD-10-D-W132XXA, ICD-10-D-V00321A, ICD-10-D-W051XXA, ICD-10-D-W1782XA, ICD-10-D-V00121A, ICD-10-D-W001XXA, ICD-10-D-W138XXA, ICD-10-D-V00311A, ICD-10-D-W100XXA, ICD-10-D-W133XXA, ICD-10-D-W134XXA, ICD-10-D-W139XXA, ICD-10-D-W12XXXA, ICD-10-D-V00181A, ICD-10-D-W130XXA, ICD-10-D-V9339XA, ICD-10-D-W15XXXA, ICD-10-D-V00891A, ICD-10-D-W131XXA, ICD-10-D-W171XXA, ICD-10-D-V815XXA, ICD-10-D-W170XXA, ICD-10-D-W173XXA
Osteoporosis-related exclusion
Osteoporosis	ICD-9-D-73300, ICD-9-D-73301, ICD-9-D-73302, ICD-9-D-73303, ICD-9-D-73309, ICD-10-DM810, ICD-10-D-M818, ICD-10-D-M816
Osteoporosis medications	GENERIC_DRUG-ALENDRONATE_SODIUM, GENERIC_DRUG-ALENDRONATE_SODIUM/VITAMIN_D3, GENERIC_DRUG-RISEDRONATE_SOD/CALCIUM_CARB, GENERIC_DRUG-RISEDRONATE_SODIUM, GENERIC_DRUG-IBANDRONATE_SODIUM, GENERIC_DRUG-ZOLEDRONIC_ACID, DRUG-FOSAMAX, DRUG-FOSAMAX_PLUS_D, DRUG-ACTONEL, DRUG-ACTONEL_WITH_CALCIUM, DRUG-RECLAST, DRUG-BONIVA, GENERIC_DRUG-TERIPARATIDE, GENERIC_DRUG-ABALOPARATIDE, DRUG-TYMLOS, DRUG-FORTEO, GENERIC_DRUG-CALCITONIN_SALMON_SYNTHETIC, DRUG-CALCITONIN-SALMON,GENERIC_DRUG-RALOXIFENE_HCL,GENERIC_DRUG-ESTROGENS_CONJ/BAZEDOXIFENE, DRUG-EVISTA, DRUG-DUAVEE, GENERIC_DRUG-DENOSUMAB, DRUG-PROLIAGENERIC_DRUG-ALENDRONATE_SODIUM, GENERIC_DRUG-ALENDRONATE_SODIUM/VITAMIN_D3, GENERIC_DRUG-RISEDRONATE_SOD/CALCIUM_CARB, GENERIC_DRUG-RISEDRONATE_SODIUM, GENERIC_DRUG-IBANDRONATE_SODIUM, GENERIC_DRUG-ZOLEDRONIC_AC/MANNITOL/0.9NACL, GENERIC_DRUG-ZOLEDRONIC_ACID, GENERIC_DRUG-ZOLEDRONIC_ACID/MANNITOL&WATER, GENERIC_DRUG-ZOLEDRONIC_ACID/MANNITOL-WATER, GENERIC_DRUG-RALOXIFENE_HCL, GENERIC_DRUG-DENOSUMAB, GENERIC_DRUG-TERIPARATIDE, GENERIC_DRUG-ABALOPARATIDE, GENERIC_DRUG-CALCITONIN_SALMON_SYNTHETIC
DEXA screening	CPT-77080, CPT-77081, CPT-77085, CPT-77086
Other exclusion
Malignancy	ICD-9-D-1960: ICD-9-D-1999, ICD-10-D-C770: ICD-10-D-C809, ICD-9-D-1400: ICD-9-D-1729, ICD-9-D-1740: ICD-9-D-1959, ICD-10-D-C000: ICD-10-D-C269, ICD-10-D-C300: ICD-10-D-C349, ICD-10-D-C370: ICD-10-D-C419, ICD-10-D-C430: ICD-10-D-C439, ICD-10-D-C450: ICD-10-D-C589, ICD-10-D-C600: ICD-10-D-C769, ICD-10-D-C970: ICD-10-D-C979
High-risk cohorts	-
Smoker	ICD-9-D-3051, ICD-9-D-98984, ICD-10-D-F17200, ICD-10-D-F17201, ICD-10-D-F17210, ICD-10-D-F17211, ICD-10-D-F17220, ICD-10-D-F17221, ICD-10-D-F17290, ICD-10-D-F17291
Alcohol abuse/dependence	ICD-9-D-2652, ICD-9-D-2911: ICD-9-D-2913, ICD-9-D-2915: ICD-9-D-2919, ICD-9-D-3030, ICD-9-D-3039, ICD-9-D-3050, ICD-9-D-3575, ICD-9-D-4255, ICD-9-D-5353, ICD-9-D-5710: ICD-9-D-5713, ICD-9-D-9800: ICD-9-D-9809, ICD-9-D-V113, ICD-10-D-F10, ICD-10-D-E52, ICD-10-D-G621, ICD-10-D-I426, ICD-10-D-K292, ICD-10-D-K700, ICD-10-D-K703, ICD-10-D-K709, ICD-10-D-T510: ICD-10-D-T519, ICD-10-D-Z502, ICD-10-D-Z714, ICD-10-D-Z721
Chronic corticosteroid usage	ICD-10-D-Z7952, ICD-9-D-V5865
Metabolic conditions affecting sex hormones and bone mineral density	ICD-9-D-2532, ICD-10-D-E230, ICD-9-D-6961, ICD-10-D-L400, ICD-10-D-L401, ICD-10-D-L404, ICD-10-D-L4050, ICD-10- D-L408, ICD-10-D-L409, ICD-9-D-2552, ICD-10-D-E259, ICD-10-D-E250, ICD-10-D-E258, ICD-9-D-042, ICD-10-D-B20, ICD-9-D-5712, ICD-9-D-5715, ICD-10-D-K7030, ICD-10-D-K7031, ICD-10-D-K717, ICD-10- D-K7460, ICD-10-D-K7469, ICD-9-D-28243, ICD-9-D-28244, ICD-10-D-D560, ICD-10-D-D561, ICD-9-D-75651, ICD-10-D-Q780, ICD-9-D-28241, ICD-9-D-28242, ICD-9-D-28260, ICD-9-D-28263, ICD-9-D-28269, ICD-9-D28264, ICD-9-D-28268, ICD-10-D-D571, ICD-10-D-D57812, ICD-10-D-D57412, ICD-10-DD57212, ICD-10-D-D57411, ICD-10-D-D57811, ICD-10-D-D57211, ICD-10-D-D57419, ICD10-D-D5780, ICD-10-D-D5740, ICD-10-D-D57819, ICD-10-D-D57219, ICD-10-D-D5720, ICD-9-D-7103, ICD-9-D-7104, ICD-9-D-725, ICD-10-D-M3390, ICD-10-D-M3220, ICD-10-DM353, ICD-9-D-4465, ICD-9-D-4464, ICD-9-D-4460, ICD-10-D-M315, ICD-10-D-M316, ICD-10-DM3130, ICD-10-D-M3131, ICD-10-D-M317, ICD-10-D-M300, ICD-10-D-M301, ICD-9-D-340, ICD-10-D-G35, ICD-9-D-24290, ICD-9-D-24200, ICD-10-D-E0590, ICD-10-D-E0500, ICD-10-D-E0520, ICD10-D-E0591, ICD-9-D-5790, ICD-10-D-K900, ICD-9-D-7140, ICD-10-D-M069, CD-9-D-5550, ICD-9-D-5551, ICD-9-D-5552, ICD-9-D-5559, ICD-10-D-K5000, ICD-10-DK50011, ICD-10-D-K50012, ICD-10-D-K50013, ICD-10-D-K50014, ICD-10-D-K50018, ICD10-D-K50019, ICD-10-D-K5010, ICD-10-D-K50111, ICD-10-D-K50112, ICD-10-D-K50113, ICD-10-D-K50114, ICD-10-D-K50118, ICD-10-D-K50119, ICD-10-D-K5080, ICD-10-DK50811, ICD-10-D-K50812, ICD-10-D-K50813, ICD-10-D-K50814, ICD-10-D-K50818, ICD10-D-K50819, ICD-10-D-K5090, ICD-10-D-K50911, ICD-10-D-K50912, ICD-10-D-K50913, ICD-10-D-K50914, ICD-10-D-K50918, ICD-10-D-K50919, ICD-10-D-K5100, ICD-10-DK51011, ICD-10-D-K51012, ICD-10-D-K51013, ICD-10-D-K51014, ICD-10-D-K51018, ICD10-D-K51019, ICD-10-D-K5180, ICD-10-D-K51811, ICD-10-D-K51812, ICD-10-D-K51813, ICD-10-D-K51814, ICD-10-D-K51818, ICD-10-D-K51819, ICD-10-D-K5190, ICD-10-DK51911, ICD-10-D-K51912, ICD-10-D-K51913, ICD-10-D-K51914, ICD-10-D-K51918, ICD10-D-K51919, ICD-9-D-7100, ICD-10-D-M3210, ICD-10-D-M329, ICD-9-D-135, ICD-10-D-D860, ICD-10-D-D861, ICD-10-D-D862, ICD-10-D-D863, ICD-10-DD8687, ICD-9-D-2550, ICD-10-D-E240, ICD-10-D-E242, ICD-10-D-E244, ICD-10-D-E248, ICD-10-DE249, ICD-9-D-25200, ICD-9-D-25201, ICD-9-D-25202, ICD-9-D-25208, ICD-9-D-58881, ICD-10-DE210, ICD-10-D-E211, ICD-10-D-E212, ICD-10-D-E213, ICD-10-D-N2581, ICD-9-D-7310, ICD-9-D-7311, ICD-10-D-M880, ICD-10-D-M881, ICD-10-D-M88811, ICD-10- D-M88812, ICD-10-D-M88819, ICD-10-D-M88821, ICD-10-D-M88822, ICD-10-D-M88829, ICD-10-D-M88831, ICD-10-D-M88832, ICD-10-D-M88839, ICD-10-D-M88841, ICD-10-DM88849, ICD-10-D-M88851, ICD-10-D-M88852, ICD-10-D-M88859, ICD-10-D-M88861, ICD10-D-M88862, ICD-10-D-M88869, ICD-10-D-M88871, ICD-10-D-M88872, ICD-10-D-M8888, ICD-10-D-M8889, ICD-10-D-M889, ICD-10-D-M9060, ICD-10-D-M90621, ICD-10-DM90641, ICD-10-D-M90651, ICD-10-D-M90652, ICD-10-D-M90661, ICD-10-D-M90671, ICD10-D-M90672, ICD-10-D-M9068, ICD-10-D-M9069, ICD-9-D-5856, ICD-10-D-N186