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Coding and prescription rates of osteoporosis are low among distal radius fracture patients in Japan

Journal of Bone and Mineral Metabolism volume 38, pages 363–370 (2020)Cite this article

Abstract

Introduction

This study aimed to clarify the coding and prescription rates for osteoporosis in distal radius fracture patients and to investigate the associated factors to help prevent subsequent osteoporotic fracture.

Materials and methods

Between 2014–2015, among 294,374 eligible individuals (42% female) aged 50–75 years in a health insurance claims database, we identified 192 individuals (mean age: 59.8 years, 74% female), counted the coding of distal radius fracture (International Statistical Classification of Diseases and Related Health Problems, 10th revision (ICD-10) code: S525, S526), and determined if the patient had been assigned the code for osteoporosis and been prescribed osteoporosis medications. Logistic regression was performed to identify factors related to each rate.

Results

The osteoporosis coding rate and osteoporosis medication prescription rate were 17.2% (n = 33) and 10.9% (n = 21), respectively. Most codes were assigned ≤ 3 months after injury (88%) at the distal radius fracture treatment facilities (84.8%). Patients who were assigned the code for osteoporosis or treated with osteoporosis medications were older (p = 0.08, p = 0.02, respectively), female (p = 0.05, p = 0.06, respectively) and having comorbidity (p = 0.02, p = 0.07, respectively). After adjustment, being female and having comorbidity remained the independent factors for the assignment of the code for osteoporosis (OR: 3.30, 95%, CI: 1.08–10.07, OR: 2.77, 95% CI: 1.24–6.12, respectively). No factor remained significant for the osteoporosis prescription. Active vitamin D analogues were most frequently prescribed medication (67%) followed by bisphosphonates (48%).

Conclusion

The overall coding and prescription rates for osteoporosis after distal radius fracture were low, which suggested that physician adherence to the osteoporosis guideline was low.

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References

  1. Mallmin H, Ljunghall S, Persson I, Naessen T, Krusemo UB, Bergstrom R (1993) Fracture of the distal forearm as a forecaster of subsequent hip fracture: a population-based cohort study with 24 years of follow-up (in eng). Calcif Tissue Int 52:269–272

    Article  CAS  Google Scholar 

  2. Cuddihy MT, Gabriel SE, Crowson CS, O’Fallon WM, Melton LJ 3rd (1999) Forearm fractures as predictors of subsequent osteoporotic fractures (in eng). Osteoporos Int 9:469–475

    Article  CAS  Google Scholar 

  3. Orimo H, Nakamura T, Hosoi T, Iki M, Uenishi K, Endo N, Ohta H, Shiraki M, Sugimoto T, Suzuki T, Soen S, Nishizawa Y, Hagino H, Fukunaga M, Fujiwara S (2012) Japanese 2011 guidelines for prevention and treatment of osteoporosis—executive summary (in eng). Arch Osteoporos 7:3–20

    Article  Google Scholar 

  4. Sanderson J, Martyn-St James M, Stevens J, Goka E, Wong R, Campbell F, Selby P, Gittoes N, Davis S (2016) Clinical effectiveness of bisphosphonates for the prevention of fragility fractures: a systematic review and network meta-analysis. Bone 89:52–58

    Article  CAS  Google Scholar 

  5. Freedman KB, Kaplan FS, Bilker WB, Strom BL, Lowe RA (2000) Treatment of osteoporosis: are physicians missing an opportunity? (in eng). J Bone Joint Surg Am 82:1063–1070

    Article  CAS  Google Scholar 

  6. Khan SA, de Geus C, Holroyd B, Russell AS (2001) Osteoporosis follow-up after wrist fractures following minor trauma (in eng). Arch Intern Med 161:1309–1312

    Article  CAS  Google Scholar 

  7. Andrade SE, Majumdar SR, Chan KA, Buist DS, Go AS, Goodman M, Smith DH, Platt R, Gurwitz JH (2003) Low frequency of treatment of osteoporosis among postmenopausal women following a fracture (in eng). Arch Intern Med 163:2052–2057

    Article  Google Scholar 

  8. Elliot-Gibson V, Bogoch ER, Jamal SA, Beaton DE (2004) Practice patterns in the diagnosis and treatment of osteoporosis after a fragility fracture: a systematic review. Osteoporos Int 15:767–778

    Article  CAS  Google Scholar 

  9. Rozental TD, Makhni EC, Day CS, Bouxsein ML (2008) Improving evaluation and treatment for osteoporosis following distal radial fractures. A prospective randomized intervention. J Bone Joint Surg Am 90:953–961

    Article  Google Scholar 

  10. Viprey M, Caillet P, Canat G, Jaglal S, Haesebaert J, Chapurlat R, Schott A-M (2015) Low osteoporosis treatment initiation rate in women after distal forearm or proximal humerus fracture: a healthcare database nested cohort study. Plos One 10:e0143842

    Article  CAS  Google Scholar 

  11. Baba T, Hagino H, Nonomiya H, Ikuta T, Shoda E, Mogami A, Sawaguchi T, Kaneko K (2015) Inadequate management for secondary fracture prevention in patients with distal radius fracture by trauma surgeons. Osteoporos Int 26:1959–1963

    Article  CAS  Google Scholar 

  12. Iba K, Dohke T, Takada J, Sasaki K, Sonoda T, Hanaka M, Miyano S, Yamashita T (2018) Improvement in the rate of inadequate pharmaceutical treatment by orthopaedic surgeons for the prevention of a second fracture over the last 10 years. J Orthop Sci 23:127–131

    Article  Google Scholar 

  13. Leslie WD, Giangregorio LM, Yogendran M, Azimaee M, Morin S, Metge C, Caetano P, Lix LM (2012) A population-based analysis of the post-fracture care gap 1996–2008: the situation is not improving. Osteoporos Int 23:1623–1629

    Article  CAS  Google Scholar 

  14. Beaton DE, Dyer S, Jiang D, Sujic R, Slater M, Sale JE, Bogoch ER, Osteoporosis Fracture Clinic Screening Program Evaluation T (2014) Factors influencing the pharmacological management of osteoporosis after fragility fracture: results from the Ontario osteoporosis strategy’s fracture clinic screening program. Osteoporos Int 25:289–296

    Article  CAS  Google Scholar 

  15. Tanihara S, Okamoto E, Une H (2011) A statistical analysis of ‘rule-out’ diagnoses in outpatient health insurance claims in Japan (in eng). J Eval Clin Pract 17:1070–1074

    Article  Google Scholar 

  16. Hajcsar EE, Hawker G, Bogoch ER (2000) Investigation and treatment of osteoporosis in patients with fragility fractures (in eng). CMAJ 163:819–822

    PubMed  PubMed Central  CAS  Google Scholar 

  17. Vanasse A, Dagenais P, Niyonsenga T, Gregoire JP, Courteau J, Hemiari A (2005) Bone mineral density measurement and osteoporosis treatment after a fragility fracture in older adults: regional variation and determinants of use in Quebec (in eng). BMC Musculoskelet Disord 6:33

    Article  Google Scholar 

  18. Tsukutani Y, Hagino H, Ito Y, Nagashima H (2015) Epidemiology of fragility fractures in Sakaiminato, Japan: incidence, secular trends, and prognosis. Osteoporos Int 26:2249–2255

    Article  CAS  Google Scholar 

  19. Rozental TD, Vazquez MA, Chacko AT, Ayogu N, Bouxsein ML (2009) Comparison of radiographic fracture healing in the distal radius for patients on and off bisphosphonate therapy (in eng). J Hand Surg Am 34:595–602

    Article  Google Scholar 

  20. Majumdar SR, Rowe BH, Folk D, Johnson JA, Holroyd BH, Morrish DW, Maksymowych WP, Steiner IP, Harley CH, Wirzba BJ, Hanley DA, Blitz S, Russell AS (2004) A controlled trial to increase detection and treatment of osteoporosis in older patients with a wrist fracture (in eng). Ann Intern Med 141:366–373

    Article  Google Scholar 

  21. Bohl DD, Singh K, Grauer JN (2016) Nationwide databases in orthopaedic surgery research (in eng). J Am Acad Orthop Surg 24:673–682

    Article  Google Scholar 

  22. Patel AA, Singh K, Nunley RM, Minhas SV (2016) Administrative databases in orthopaedic research: pearls and pitfalls of big data (in eng). J Am Acad Orthop Surg 24:172–179

    Article  Google Scholar 

  23. Kirigaya D, Nakayama T, Ishizaki T, Ikeda S, Satoh T (2011) Management and treatment of osteoporosis in patients receiving long-term glucocorticoid treatment: current status of adherence to clinical guidelines and related factors. Intern Med 50:2793–2800

    Article  CAS  Google Scholar 

  24. Kuboyama I, Toyokawa S, Tomio J, Inada H, Tanihara S, Kobayashi Y (2016) The number of patients and therapeutic profile of spinal stenosis using health insurance claims in Japan (in eng). Spine 41:1146–1152

    Article  Google Scholar 

  25. Tanaka S, Yamamoto T, Oda E, Nakamura M, Fujiwara S (2018) Real-world evidence of raloxifene versus alendronate in preventing non-vertebral fractures in Japanese women with osteoporosis: retrospective analysis of a hospital claims database. J Bone Miner Metab 36:87–94

    Article  CAS  Google Scholar 

  26. Tanihara STM, Kawazoe M, Yamanoguchi M, Shimura H (2017) Shakai iryou shinryoukoui betsu tyousa to kennpokumiai receipt data ni okeru syoubyou daibunruibetsu jinkou atari receipt kensuu no hikaku (in Japanese). J Health Welf Stat 64:1–8

    Google Scholar 

  27. Haut ER, Pronovost PJ, Schneider EB (2012) Limitations of administrative databases (in eng). Jama 307:2589 (author reply 89–90 )

    PubMed  CAS  Google Scholar 

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Acknowledgements

This work was partly funded by the Research Project for the Analysis of the Utilization of Health Care Services and Estimation of the Number of Patients Based on the Patient Survey (H27-Statistics-Ippan-001) and by the Research Project for the Validity and Application of the Estimated Number of Patients Based on the Patient Survey (H29-Statistics-Ippan-003) from the Ministry of Health, Labor, and Welfare of Japan.

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Affiliations

  1. Department of Orthopaedics, Teikyo University School of Medicine, 1-2-11, Kaga, Itabashi, Tokyo, Japan

    Natsumi Saka, Yoshinobu Watanabe & Hirotaka Kawano

  2. Department of Public Health, Akita University School of Medicine, 1-1 Tegatagakuenmachi, Akita, 010-8502, Japan

    Kyoko Nomura

  3. Graduate School of Public Health, Teikyo University, 1-2-11, Kaga, Itabashi, Tokyo, Japan

    Kyoko Nomura, Hoichi Amano, Kenichi Fujimoto & Shinichi Tanihara

  4. Department of Social and Behavioral Sciences, Harvard. T.H. Chan School of Public Health, 677 Huntington Ave, Boston, MA, 02115, USA

    Hoichi Amano

  5. Department of Public Health, Kurume University School of Medicine, 67 Asahimachi, Kurume, Fukuoka, 830-0011, Japan

    Shinichi Tanihara

Authors
  1. Natsumi Saka
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  2. Kyoko Nomura
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  3. Hoichi Amano
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  4. Kenichi Fujimoto
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  5. Yoshinobu Watanabe
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  6. Hirotaka Kawano
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  7. Shinichi Tanihara
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Contributions

NS designed the study and wrote the initial draft of the manuscript. KN and TS contributed to analysis and interpretation of data and assisted in the preparation of the manuscript. All other authors contributed to data collection and interpretation and critically reviewed the manuscript. All authors approved the final version of the manuscript and agree to be accountable for all aspects of the work by ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved

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Correspondence to Shinichi Tanihara.

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Saka, N., Nomura, K., Amano, H. et al. Coding and prescription rates of osteoporosis are low among distal radius fracture patients in Japan. J Bone Miner Metab 38, 363–370 (2020). https://doi.org/10.1007/s00774-019-01067-z

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  • DOI: https://doi.org/10.1007/s00774-019-01067-z

Keywords

  • Adherence
  • Distal radius fracture
  • Fragility fracture
  • Guideline
  • ICD-10 coding