title: Prevalence and risk of fracture diagnoses in women across the adult life span: a national cross-sectional study.
abstract: In a national sample of women veterans, the rate of lower limb fracture diagnosis was the highest across ages 18-74 years; rates of fracture diagnosis of other skeletal sites peaked in women aged 75+. Women with two or more primary care visits or mental healthcare visits had elevated odds of fracture diagnosis.
  
  
  
  We assessed the prevalence and healthcare utilization characteristics associated with a diagnosis of any fracture in women of all adult ages within the Veterans Health Administration.
  
  
  
  In 344,488 women during fiscal year 2012, logistic regression models for fracture diagnosis included age, race/ethnicity, residence, number of primary care visits, number of mental healthcare visits, and degree of service-connected disability.
  
  
  
  Lower limb fracture diagnosis was most prevalent across ages 18-74 years and peaked in women aged 55-64 years. In women aged 75+, the prevalence rates of fracture diagnosis at the hip (102, 95 % CI = 88-115 per 10,000 women), upper limb (100, 95 % CI = 87-114 per 10,000 women), and lower limb (84, 95 % CI = 72-97 per 10,000 women) were the highest. Fractures at other skeletal sites peaked in those aged 75+ years. Black women had the lowest odds of a fracture diagnosis, followed by Asian/Pacific Islander and Hispanic women compared to non-Hispanic White (by 25-51 %, P < 0.05). Having two or more primary care visits or any mental health visit was each associated with an increased risk. Women with five or more primary care visits had a 3.36-fold (95 % CI = 3.02-3.75) greater odds than those with no such visit, and separately, women with five or more mental health visits had a 1.51-fold (95 % CI = 1.43-1.60) greater odds. Women with a fracture diagnosis had higher overall healthcare costs than those without (P < 0.001).
  
  
  
  Prevalence of fracture diagnosis differed by age, race/ethnicity, and skeletal site of fracture. Fracture diagnosis may identify women veterans with greater overall healthcare needs.
authors.affiliation: Division of Endocrinology, Gerontology, and Metabolism, Department of Medicine, Stanford University, Stanford, CA, USA.
authors.forename: P Y
authors.initials: PY
authors.lastname: Chang
authors.affiliation: Medical Services, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, 94304, USA.|VA HSR&D Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Palo Alto, CA, USA.
authors.forename: F S
authors.initials: FS
authors.lastname: Saechao
authors.affiliation: Medical Services, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, 94304, USA.|VA HSR&D Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Palo Alto, CA, USA.
authors.forename: J
authors.initials: J
authors.lastname: Lee
authors.affiliation: VA Connecticut Healthcare System; Women's Health Services, Veterans Health Administration, West Haven, CT, USA.|General Internal Medicine, Department of Medicine, Yale School of Medicine, New Haven, CT, USA.
authors.forename: S G
authors.initials: SG
authors.lastname: Haskell
authors.affiliation: Medical Services, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, 94304, USA.|VA HSR&D Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Palo Alto, CA, USA.|Division of General Medical Disciplines, Stanford University School of Medicine, Stanford, CA, USA.
authors.forename: S M
authors.initials: SM
authors.lastname: Frayne
authors.affiliation: Division of Endocrinology, Gerontology, and Metabolism, Department of Medicine, Stanford University, Stanford, CA, USA. jennifer.lee23@va.gov.|Medical Services, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, 94304, USA. jennifer.lee23@va.gov.|VA HSR&D Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Palo Alto, CA, USA. jennifer.lee23@va.gov.|VA Palo Alto Cooperative Studies Program Coordinating Center, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA. jennifer.lee23@va.gov.
authors.forename: J S
authors.initials: JS
authors.lastname: Lee
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D005260:Female; D050723:Fractures, Bone / Q000453:epidemiology*; D006801:Humans; D008875:Middle Aged; D015995:Prevalence; D012307:Risk Factors; D014481:United States; D014493:United States Department of Veterans Affairs; D055815:Young Adult
keywords: Fracture; Health services; Life course; Veterans; Women