title: "Pathologic" fractures: should these be included in epidemiologic studies of osteoporotic fractures?
abstract: 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.
  
  
  BACKGROUND
  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 > or =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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, AL, USA. jcurtis@uab.edu
authors.forename: J R
authors.initials: JR
authors.lastname: Curtis
authors.forename: A J
authors.initials: AJ
authors.lastname: Taylor
authors.forename: R S
authors.initials: RS
authors.lastname: Matthews
authors.forename: M N
authors.initials: MN
authors.lastname: Ray
authors.forename: D J
authors.initials: DJ
authors.lastname: Becker
authors.forename: L C
authors.initials: LC
authors.lastname: Gary
authors.forename: M L
authors.initials: ML
authors.lastname: Kilgore
authors.forename: M A
authors.initials: MA
authors.lastname: Morrisey
authors.forename: K G
authors.initials: KG
authors.lastname: Saag
authors.forename: A
authors.initials: A
authors.lastname: Warriner
authors.forename: E
authors.initials: E
authors.lastname: Delzell
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001859:Bone Neoplasms / Q000150:complications / Q000453:epidemiology; D005260:Female; D005598:Fractures, Spontaneous / Q000453:epidemiology* / Q000209:etiology; D006620:Hip Fractures / Q000453:epidemiology / Q000209:etiology; D006801:Humans; D015994:Incidence; D008297:Male; D006278:Medicare; D058866:Osteoporotic Fractures / Q000453:epidemiology*; D016103:Spinal Fractures / Q000453:epidemiology / Q000209:etiology; D014481:United States / Q000453:epidemiology