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.
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Acknowledgements
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).
Conflicts of interest
JRC: Consulting: Roche, UCB, Procter & Gamble; speakers bureau: Merck, Procter & Gamble, Eli Lilly, Roche, Novartis; research grants: Merck, Procter & Gamble, Eli Lilly, Amgen, Novartis
RM: Research grants: Amgen
AT: Research grants: Amgen
MR: None
DJB: Research grants: Amgen
LG: Research grants: Amgen
MLK: Consulting and Research grants: Amgen, Eli Lilly
MM: Research grants: Amgen
KGS: Consulting: Amgen, Aventis, Eli Lilly, Merck, Novartis; Procter & Gamble, Roche, UCB; Speakers bureau: Novartis; Research grants: Novartis, Amgen, Eli Lilly, Roche
ED: Research grants: Amgen
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Curtis, J.R., Taylor, A.J., Matthews, R.S. et al. “Pathologic” fractures: should these be included in epidemiologic studies of osteoporotic fractures?. Osteoporos Int 20, 1969–1972 (2009). https://doi.org/10.1007/s00198-009-0840-2
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DOI: https://doi.org/10.1007/s00198-009-0840-2