Concept: Osteoporosis - Measuring Prevalence

Introduction

Osteoporosis is a disease that leads to a reduction in bone density, causing the bones to become weak and more likely to break. This concept describes the methods used at MCHP to define and identify osteoporosis.

Methods of Defining Osteoporosis in MCHP Research

Over time, different methods for defining osteoporosis have been used in MCHP research.

1. Fransoo et al. (2009), Martens et al. (2010), Chartier et al. (2012) and Fransoo et al. (2013)

In the following deliverables:


• Manitoba RHA Indicators Atlas 2009 by Fransoo et al. (2009);
  
• Profile of Metis Health Status and Healthcare Utilization in Manitoba: A Population-Based Study by Martens et al. (2010);
  
• Health and Healthcare Utilization of Francophones in Manitoba by Chartier et al. (2012); and
  
• The 2013 RHA Indicators Atlas by Fransoo et al. (2013)

... osteoporosis is defined by one of the following conditions:


• one or more hospitalizations with one of the following diagnoses:
  
  • osteoporosis, ICD-9-CM code 733.0; ICD-10-CA code M81
    
  • hip fracture, ICD-9-CM code 820-821; ICD-10-CA code S72
    
  • spine fracture, ICD-9-CM code 805; ICD-10-CA codes S12.0-S12.2, S12.7, S12.9, S22.0, S22.1, S32.0-S32.2, T08
    
  • humerus fracture, ICD-9-CM code 812; ICD-10-CA codes S42.2-S42.4
    
  • wrist fracture (radius, ulna and carpal bones), ICD-9-CM code 813-814; ICD-10-CA codes S52, S62.0, S62.1; or
  
  
• one or more physician visits with one of the following diagnoses:
  
  
  • osteoporosis, ICD-9-CM code 733,
    
  • hip fracture, ICD-9-CM code 820-821,
    
  • spine fracture, ICD-9-CM code 805,
    
  • humerus fracture, ICD-9-CM code 812,
    
  • wrist fracture, ICD-9-CM code 813-814; or
  
  
• one or more prescriptions for medications to treat osteoporosis, as listed below (with ATC code(s) and generic drug name):
  
  
  • In Fransoo et al. (2009), Martens et al. (2010) and Chartier et al. (2012):
    
    
    • Selective Estrogen Receptor Modulators - G03XC01 - Raloxifene
      
    • Parathyroid Hormones and Analogues - H05AA02 - Teriparatide
      
    • Calcitonin Preparations - H05BA01 - Calcitonin (salmon synthetic)
      
    • Bisphosphonates:
      
      • M05BA01 - Etidronic acid,
        
      • M05BA02 - Clodronic acid,
        
      • M05BA03 - Pamidronic acid,
        
      • M05BA04 - Alendronic acid,
        
      • M05BA07 - Risedronic acid, and
        
      • M05BB01 - Etidronic acid and calcium, sequential
    
    
  • In Fransoo et al. (2013):
    
    
    • G03XC01 - raloxifene
      
    • H05AA02 - teriparatide
      
    • H05BA01 - calcitonin (salmon synthetic)
      
    • M05BA04 - alendronic acid
      
    • M05BA07 - risedronic acid
      
    • M05BA08 - zoledronic acid
      
    • M05BB01 - etidronic acid and calcium
      
    • M05BB02 - risedronic acid and calcium
      
    • M05BB03 - alendronic acid and vitamin D
      
    • M05BB04 - risedronic acid and calcium and vitamin D
      
    • M05BX04 - denosumab

NOTES:


• this definition is restricted to residents aged 50 and older.
  
• fractures in hospital associated with a diagnosis code for a major trauma, like crushing injuries or motor vehicle accidents, are excluded. These include ICD-9-CM codes 925-929, E800-E848; ICD-10-CA codes S07, S17, S18, S28.0, S38, S47, S57, S67, S77, S87, S97, T04, T14.7, V01-V99.

Further Information

For more information regarding osteoporosis, please read the related sections from the following reports:


• 4.6 Osteoporosis in the Manitoba RHA Indicators Atlas 2009 (2009) deliverable.
  
• 5.7 Osteoporosis in the Profile of Metis Health Status and Healthcare Utilization in Manitoba: A Population-Based Study (2010) deliverable.
  
• 5.9 Osteoporosis in the Health and Healthcare Utilization of Francophones in Manitoba (2012) deliverable.
  
• 4.10 Osteoporosis Prevalence in The 2013 RHA Indicators Atlas (2013) deliverable.

2. Martens et al. (2015)

In The Cost of Smoking: A Manitoba Study deliverable by Martens et al. (2015) they calculated osteoporosis prevalence rates two ways; one using administrative data and the other using self-reported survey data. Using the administrative data, the weighted crude prevalence of osteoporosis was calculated for survey respondents aged 50 and older in the three years before their survey date. Osteoporosis was defined by one of the following conditions:


• one or more hospitalizations with a diagnosis of osteoporosis, ICD-9-CM code 733.0; ICD-10-CA code M81;
  
• one or more physician visits with a diagnosis of osteoporosis, ICD-9-CM code 733; or
  
• one or more prescriptions for medications to treat osteoporosis. See the list of drugs to treat osteoporosis from this report.

Using survey data, a different method for identifying osteoporosis was required. Since the Drug Program Information Network (DPIN) data were not available for respondents of the Manitoba Heart Health Survey (MHHS), these respondents were excluded from the prevalence calculations. In the Canadian Community Health Survey (CCHS) 2.2 and the CCHS Healthy Aging Survey, respondents aged 50 and older were asked, "Do you have osteoporosis?- Possible responses include "yes", "no" or "don't know". The weighted crude self-reported prevalence of osteoporosis was calculated for survey respondents aged 50 and older as the percentage of respondents who answered "yes" out of all respondents who gave a valid answer. Respondents who answered "don't know" or those with inapplicable, missing, or invalid data were excluded from the prevalence calculation.

For more information on the prevalence rates of osteoporosis from survey (self-reported) and administrative data from The Cost of Smoking: A Manitoba Study deliverable, see Table 4.8 Chronic Diseases of Estimated-Population-Based Sample* at Time of Survey by Smoking Status Categories in Martens et al. (2015).

Fransoo et al. (2019)

In The 2019 RHA Indicators Atlas by Fransoo et al. (2019) they defined osteoporosis prevalence for Manitoba residents aged 50 and older using the following conditions:


• at least one hospitalization or physician visit with a diagnosis of ICD–9–CM code 733 or ICD–10–CA code M81, or
  
• at least one dispensation of medications used to treat osteoporosis. See the Deliverable online supplement for the list of medications used in this research.

For more information, please read section 4.9 Osteoporosis Prevalence in the online deliverable.

Notes / Cautions

• These definitions will under-count the true number of fractures because some patients will have been treated in Emergency Departments at which individual-level physician claims data are not routinely collected; this includes urban community hospitals and many rural hospitals.