title: Impact of radiographic vertebral fractures on inpatient healthcare utilization in older women.
abstract: Vertebral fractures (VFx) are the most common osteoporotic fracture and are associated with higher risk of impaired function, additional fractures and death. The purpose of this analysis was to test the hypotheses that VFx are also associated with greater inpatient healthcare utilization.
  
  
  
  We studied 4709 Caucasian women enrolled in the Study of Osteoporotic Fractures (SOF) and merged SOF cohort data with Medicare claims or Kaiser encounter data. To be included in this analysis, women had to be enrolled in Medicare Fee for Service or Kaiser as of 1/1/1991 and have radiographic information on VFx status at SOF Visit 3 (1991-92). VFx status was assessed using quantitative morphometry on lateral thoracic and lumbar spine radiographs. Prevalent VFx were defined as any height ratio>3 standard deviations below normal. Women were considered to have a clinical VFx if they reported a new diagnosis of VFx and a clinical radiographic report that confirmed that a VFx was present. Any hospitalization and the number of annualized days of hospitalization were identified through inpatient claims or encounter data. Specific hospitalizations for 5 major common reasons for hospitalizations were also examined.
  
  
  
  Over 5-years, 2632 (55.9%) women were hospitalized. In multivariate adjusted models, women with a prevalent radiographic VFx were 21% (95% CI, 2-44%) more likely to be hospitalized for any reason. This association was independent of a number of risk factors including smoking. The annualized rate of inpatient day was, however, similar, 1.67 and 1.48 among women with and without a VFx, respectively, p=0.49. Women with an incident clinical VFx were more likely to be hospitalized including women without evidence of a prevalent radiographic VFx (odds ratio (OR)=5.33; 95% confidence interval (CI)=1.81-15.71) and women with a prevalent radiographic VFx (OR=2.13; 95% CI, 1.05-4.33). Women with a VFx were more likely to be hospitalized specifically for hip fracture or chronic obstructive pulmonary disease (COPD) but not stroke, myocardial infarction or congestive heart failure. The association with COPD was attenuated to non-significance after adjusting for smoking.
  
  
  
  Our results extend the potential public health impact of radiographic and clinical VFx to include an increased risk of any hospitalization.
authors.affiliation: Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA, United States. Electronic address: jcauley@edc.pitt.edu.
authors.forename: Jane A
authors.initials: JA
authors.lastname: Cauley
authors.affiliation: California Pacific Medical Center Research Institute, San Francisco, CA, United States. Electronic address: LLui@psg.ucsf.edu.
authors.forename: Li-Yung
authors.initials: LY
authors.lastname: Lui
authors.affiliation: NORC at the University of Chicago, Health Care Department, Bethesda, MD, United States. Electronic address: ames0047@umn.edu.
authors.forename: Misti L
authors.initials: ML
authors.lastname: Paudel
authors.affiliation: NORC at the University of Chicago, Health Care Department, Bethesda, MD, United States; Department of Medicine, University of Minnesota, Minneapolis, MN, United States; Center for Chronic Disease Outcomes Research, VA Health Care System, Minneapolis, MN, United States. Electronic address: taylorbc@umn.edu.
authors.forename: Brent C
authors.initials: BC
authors.lastname: Taylor
authors.affiliation: California Pacific Medical Center Research Institute, San Francisco, CA, United States. Electronic address: PCawthon@sfcc-cpmc.net.
authors.forename: Peggy M
authors.initials: PM
authors.lastname: Cawthon
authors.affiliation: Center for Health Research, Kaiser Permanente Northwest, Portland, OR, United States. Electronic address: Teresa.Hillier@kpchr.org.
authors.forename: Teresa A
authors.initials: TA
authors.lastname: Hillier
authors.affiliation: Park Nicollet Clinic, St. Louis Park, MN, United States; Division of Health Policy & Management, University of Minnesota, Minneapolis, MN, United States. Electronic address: John.Schousboe@ParkNicollet.com.
authors.forename: John T
authors.initials: JT
authors.lastname: Schousboe
authors.affiliation: University of California, San Francisco, San Francisco, CA, United Sates. Electronic address: Charles.McCulloch@ucsf.edu.
authors.forename: Charles E
authors.initials: CE
authors.lastname: McCulloch
authors.affiliation: NORC at the University of Chicago, Health Care Department, Bethesda, MD, United States; Department of Medicine, University of Minnesota, Minneapolis, MN, United States; Center for Chronic Disease Outcomes Research, VA Health Care System, Minneapolis, MN, United States. Electronic address: Kristine.Ensrud@va.gov.
authors.forename: Kristine E
authors.initials: KE
authors.lastname: Ensrud
mesh_terms: D000368:Aged; D003695:Delivery of Health Care / Q000706:statistics & numerical data*; D005260:Female; D006760:Hospitalization; D006801:Humans; D007297:Inpatients; D016016:Proportional Hazards Models; D016103:Spinal Fractures / Q000000981:diagnostic imaging*
keywords: Epidemiology; Health economics; Health services research; Healthcare utilization; Osteoporosis; Vertebral fractures