Identification and Validation of Vertebral Compression Fractures Using Administrative Claims Data

Curtis, Jeffrey R.; Mudano, Amy S.; Solomon, Daniel H.; Xi, Juan; Melton, Mary E.; Saag, Kenneth G.

doi:10.1097/mlr.0b013e3181808c05

Cited by 104 publications

(95 citation statements)

References 8 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Fracture ascertainment from administrative data sources may be incomplete, particularly for vertebral fractures, although similar algorithms have proven useful for both vertebral and nonvertebral fracture identification. (37,38) We used a FRAX tool that has been directly validated in the Canadian population, (26,27) but there was incomplete information on some of the baseline clinical risk factors (eg, parental hip fracture), and for others proxies were used (eg, smoking, alcohol intake) as previously described. (25) Despite these limitations, predicted 10-year fracture probability agreed very closely with the observed fracture incidence estimated to 10 years among untreated women, suggesting reasonably complete ascertainment of fractures and risk factors.…”

Section: Discussionmentioning

confidence: 99%

Does osteoporosis therapy invalidate FRAX for fracture prediction?

Leslie

Lix

Johansson

et al. 2012

Journal of Bone and Mineral Research

115

View full text Add to dashboard Cite

Ten-year fracture risk assessment with the fracture risk assessment system (FRAX) is increasingly used to guide treatment decisions. Osteoporosis pharmacotherapy reduces fracture risk, but the effect is greater than can be explained from the increase in bone mineral density (BMD). Whether this invalidates fracture predictions with FRAX is uncertain. A total of 35,764 women (age !50 years) and baseline BMD testing (1996)(1997)(1998)(1999)(2000)(2001)(2002)(2003)(2004)(2005)(2006)(2007) had FRAX probabilities retroactively calculated. A provincial pharmacy database was used to identify osteoporosis medication use. Women were categorized as untreated, current high adherence users [medication possession ratio (MPR) !0.80 in the year after BMD testing], current low adherence users (MPR <0.80), and past users. Fractures outcomes to 10 years were established form a population-based health data repository. FRAX and femoral neck BMD alone stratified major osteoporotic and hip fracture risk within untreated and each treated subgroup (all p-values <0.001) with similar area under the receiver operating characteristic curve. In untreated and each treated subgroup, a stepwise gradient in observed 10-year major osteoporotic and hip fracture incidence was found as a function of the predicted probability tertile (all p-values <0.001 for linear trend). Concordance (calibration) plots for major osteoporotic fractures and hip fractures showed good agreement between the predicted and observed 10-year fracture incidence in untreated women and each treated subgroup. Only in the highest risk tertile of women highly adherent to at least 5 years of bisphosphonate use was observed hip fracture risk significantly less than predicted, though major osteoporotic fracture risk was similar to predicted. In summary, this work suggests that the FRAX tool can be used to predict fracture probability in women currently or previously treated for osteoporosis. Although FRAX should not be used to assess the reduction in fracture risk in individuals on treatment, it may still have value for guiding the need for continued treatment or treatment withdrawal. ß

show abstract

Section: Discussionmentioning

confidence: 99%

Does osteoporosis therapy invalidate FRAX for fracture prediction?

Leslie

Lix

Johansson

et al. 2012

Journal of Bone and Mineral Research

115

View full text Add to dashboard Cite

show abstract

“…Notwithstanding these legitimate difficulties, administrative definitions for vertebral fractures have been developed and tested with acceptable results. (30) Since the predominant difficulty is underrecognition of vertebral fractures, this actually would introduce a bias against the hybrid system, as noted earlier.…”

Section: Discussionmentioning

confidence: 99%

Absolute fracture risk assessment using lumbar spine and femoral neck bone density measurements: Derivation and validation of a hybrid system

Leslie

Lix

2010

Journal of Bone and Mineral Research

View full text Add to dashboard Cite

The World Health Organization (WHO) Fracture Risk Assessment Tool (FRAX) computes 10-year probability of major osteoporotic fracture from multiple risk factors, including femoral neck (FN) T-scores. Lumbar spine (LS) measurements are not currently part of the FRAX formulation but are used widely in clinical practice, and this creates confusion when there is spine-hip discordance. Our objective was to develop a hybrid 10-year absolute fracture risk assessment system in which nonvertebral (NV) fracture risk was assessed from the FN and clinical vertebral (V) fracture risk was assessed from the LS. We identified 37,032 women age 45 years and older undergoing baseline FN and LS dual-energy X-ray absorptiometry (DXA; 1990) from a population database that contains all clinical DXA results for the Province of Manitoba, Canada. Results were linked to longitudinal health service records for physician billings and hospitalizations to identify nontrauma vertebral and nonvertebral fracture codes after bone mineral density (BMD) testing. The population was randomly divided into equal-sized derivation and validation cohorts. Using the derivation cohort, three fracture risk prediction systems were created from Cox proportional hazards models (adjusted for age and multiple FRAX risk factors): FN to predict combined all fractures, FN to predict nonvertebral fractures, and LS to predict vertebral (without nonvertebral) fractures. The hybrid system was the sum of nonvertebral risk from the FN model and vertebral risk from the LS model. The FN and hybrid systems were both strongly predictive of overall fracture risk (p < .001). In the validation cohort, ROC analysis showed marginally better performance of the hybrid system versus the FN system for overall fracture prediction (p ¼ .24) and significantly better performance for vertebral fracture prediction (p < .001). In a discordance subgroup with FN and LS T-score differences greater than 1 SD, there was a significant improvement in overall fracture prediction with the hybrid method (p ¼ .025). Risk reclassification under the hybrid system showed better alignment with observed fracture risk, with 6.4% of the women reclassified to a different risk category. In conclusion, a hybrid 10-year absolute fracture risk assessment system based on combining FN and LS information is feasible. The improvement in fracture risk prediction is small but supports clinical interest in a system that integrates LS in fracture risk assessment. ß

show abstract

“…Osteoporosis and fracture algorithms using diagnostic codes found in administrative databases have been constructed and validated for surveillance purposes [5][6][7][8][9][10][11]. Leslie et al validated algorithms to identify cases of diagnosed osteoporosis using administrative data and demonstrated that a relatively simple algorithm which combined hospitalizations and physician visits could achieve an acceptable level of sensitivity, specificity, and accuracy [5].…”

Section: Introductionmentioning

confidence: 99%

Use of administrative data for national surveillance of osteoporosis and related fractures in Canada: results from a feasibility study

O’Donnell

2013

Arch Osteoporos

View full text Add to dashboard Cite

Summary-Using administrative data healthcare databases from five Canadian provinces, we compared prevalence estimates of diagnosed osteoporosis and incidence rates for related fractures in Canada. The algorithms adopted showed consistent age and sex patterns across all provinces and will be suitable for national surveillance and monitoring.Purpose-This study aims to evaluate the feasibility of using provincial population-based administrative data to develop a national surveillance system of diagnosed osteoporosis and related fractures (forearm, humerus, vertebra, pelvis, and hip) in Canada.Methods-Linked healthcare databases from five provinces representing approximately 85 % of the Canadian population were used. Multiple algorithms combining hospitalizations, physician visits, and osteoporosis prescription drug dispensations were evaluated in each province. The adopted algorithms for diagnosed osteoporosis and incident fractures combined hospitalizations and physician visits based on 3 years and 1 year of data, respectively. Sex-specific agestandardized osteoporosis prevalence and fracture incidence rates were estimated for each province from

show abstract

Identification and Validation of Vertebral Compression Fractures Using Administrative Claims Data

Abstract: Introduction-Vertebral compression fractures (VCFs) are the most common type of osteoporotic fracture. Administrative claims data might be useful to identify VCFs, but this approach to case finding has received limited evaluation.

Cited by 104 publications

References 8 publications

Does osteoporosis therapy invalidate FRAX for fracture prediction?

Does osteoporosis therapy invalidate FRAX for fracture prediction?

Absolute fracture risk assessment using lumbar spine and femoral neck bone density measurements: Derivation and validation of a hybrid system

Use of administrative data for national surveillance of osteoporosis and related fractures in Canada: results from a feasibility study

Contact Info

Product

Resources

About