An indirect method for the estimation of osteoporotic fractures from injury and fracture profiles

Abstract

Study objective was to develop a valid epidemiological method for the estimation of osteoporotic fracture risk, using administrative databases and accounting for variable baseline risks of injury. Design is the secondary analysis of inpatient and outpatient utilization data. A baseline injury risk was estimated by the incidence of primary utilization of medical services for soft tissue injuries (ICD-9 diagnostic codes 910-929), and the risk profile was compared after normalization with the overall primary utilization rate for fractures (ICD-9 diagnostic codes 800-829). The setting is a county with approximately 100,000 inhabitants in the former East Germany. Participants were all inhabitants of the county who had a physician contact (inpatient or outpatient) during 1987-1988, as well as hospital inpatients for all of Germany in 1989. The number of fractures increased with age, especially in women, when compared to the number of fractures expected from the incidence of soft tissue injury. Similar patterns were identified in hospitalization data from East and West Germany. Estimating the prevalence of osteoporosis directly from certain "osteoporotic" fracture types associated with higher age is potentially biased, since it neglects the underlying risk of injury. Our model distinguished the osteoporotic fracture risk as the excess risk over an expected injury-related fracture risk for a given age and sex, and may allow a more valid quantification of osteoporotic fractures in different populations.

Estimation of injury events, rates, and risks from existing databases

“…The methods have mainly included mathematical and statistical modelling as well as use of algorithms and the captureÀrecapture methods (Davie, Samaranayaka, Langley, & Barson, 2011;Forjuoh, Keyl, & Diener-West, 1997;Wildner, Clark, Casper, & Bergmann, 1999). Linkages of data across multiple sources and multiple imputation methods have also been used, particularly in relation to injury surveillance .…”

“…In addition, they acknowledged several assumptions with both methods, including the assumption of uniform distribution of children's ages within preset age groups and a uniform distribution of the age at which the burn occurred within each group. Wildner et al (1999) also estimated osteoporotic fracture risk from injury and fracture profiles using population-based inpatient and outpatient data in the former East Germany. They estimated a baseline injury risk by the incidence of primary utilization of medical services for soft tissue injuries and compared the risk profile after normalization with the overall primary utilization rate for fractures.…”

Stationäre Inanspruchnahme bei muskuloskelettalen Erkrankungen und Verletzungen: Vorausberechnung für Deutschland bis zum Jahr 2010

“…So ist z. B. die Zunahme der Gesamtzahl an behandlungsbedürftigen Frakturen im höheren Lebensalter eine Folge der Zunahme an alten Menschen und gleichzeitig eine Folge eines davon unabhängigen beständig steigenden altersspezifischen Risikos für osteoporotische Frakturen insbesondere älterer Frauen [11,12]. Nach Kappler und Theurl sind die veränderten Morbiditätsstrukturen dabei "erstens Mitursache der Verschiebung der demografischen Struktur, zweitens Folge dieser Verschiebung und drittens Begleiterscheinung derselben …" [13].…”