Celiac disease is associated with decreased bone density, but there are conflicting data regarding fracture risk. We determined the fracture incidence relative to matched controls in a population-based cohort with celiac disease before and after diagnosis. Olmsted County residents with celiac disease (n = 83) diagnosed between 1950 and 2002 were compared with 166 gender and age matched controls. Fracture histories were ascertained from each subject's medical records. Celiac disease is linked to an increased fracture risk before and after diagnosis. Before the index date, cases had a fracture rate twice that of controls (CI: 1.0-3.9, P = 0.045) and 2.5-fold greater after the index date (CI: 1.1-5.6, P = 0.026). Appendicular and axial fractures were 2.5 (CI: 0.9-6.5) and 3.2 times more likely (CI: 1.0-10.5) after the index date. These observations support a rationale for earlier detection of celiac disease, and active management of bone disease before bone effects have occurred, to reduce the persistent risk of fractures.

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The PPV was moderately high, reflecting the rate of false positives and relatively low volume of IVF. Of the 51 false positives, primary chart review identified 22 (43%) as canceled IVF cycles and 18 (35%) as IVF cycles likely occurring outside the healthcare network covered by the insurance policy.CONCLUSIONS: A claims-based algorithm using paired pelvic ultrasounds and hormonal medications commonly used for IVF has high sensitivity, specificity, NPV, and accuracy for predicting IVF cycles. This algorithm will be useful for researchers, policymakers, and clinicians who aim to better understand large scale IVF practice patterns using administrative claims data.