Consistent with available resources to perform medical record reviews, we selected a total of 235 patients for validation, including all patients with suspected subtrochanteric femoral fracture (n=137) and random samples of patients with diaphyseal femoral fracture (n=50), and hip fracture other than subtrochanteric and diaphyseal femoral fractures (typical hip fracture) (n=50) ( Figure 1). Individuals with hospital discharge diagnosis for open femoral fracture and distal end femoral fractures were excluded because these fractures are usually caused by major trauma and not associated with longer term bisphosphonates use ( Appendix 1). We identified 2,133 patients admitted to UAB hospital and having a discharge diagnosis of femoral fracture from Januto December 31, 2008. The ICD-9 codes used for selection are listed in Appendix 1.
In order to develop and validate claims-based algorithms for identification of subtrochanteric and diaphyseal femoral fractures, hip fractures other than subtrochanteric and diaphyseal femoral fracture (typical hip fractures) and atypical femoral fractures, we assessed the accuracy of hospital and physician diagnosis codes to identify these fractures.Įligibility and Identification of Suspected Femoral FracturesĬandidates for study inclusion were all patients with an ICD-9 diagnosis code for femoral fracture on their hospital discharge summary diagnosis list these candidates were defined as having suspected fractures. In another cohort of women aged 68 years or older ICD-10 codes had a 90% PPV (95% CI 88-92) for patients hospitalized with a subtrochanteric and diaphyseal femoral fractures. In contrast, Spangler et al recently reported PPV for the various diaphyseal femoral fracture ICD-9 sub-codes that ranged from 20-83% and a PPV of 50% for subtrochanteric femoral fracture ICD-9 code.
Ray et al reported a PPV of 75% for the diaphyseal femoral fracture ICD-9 (International Classification of Diseases, Ninth Revision, Clinical Modification) code. While administrative claims data have been used to define some common types of fractures as well as those with radiographic features considered atypical, to our knowledge, few studies have assessed the positive predictive value (PPV) of subtrochanteric and diaphyseal femoral fracture codes. However, the accuracy of administrative claims to identify certain fracture types is not well established. Administrative claims databases often provide a unique population-base useful for such studies. īecause of cost, feasibility and generalizability concerns of conducting long-term safety studies using randomized controlled trials, large observational studies are commonly utilized to clarify these associations. Recently, a population-based, nested case-control study in Canada, also relying on administrative data, demonstrated an association between long-term bisphosphonate use and subtrochanteric or femoral shaft fractures. Secondary analyses using results of three large, randomized bisphosphonate trials also demonstrated very rare occurrences of subtrochanteric or diaphyseal femoral fractures and showed no significantly increased risk even among women who were treated with bisphosphonates for nearly 10 years. On the other hand, a registry-based cohort study in Denmark that used administrative data showed no difference in the incidence rate of hip and subtrochanteric / diaphyseal femur fractures between alendronate users and a matched comparison group.
ICD 10 CODE FOR SUPRACONDYLAR FRACTURE SERIES
Multiple case reports and small case series have raised concern about a possible association of such fractures with long term bisphosphonates use. The occurrences of these fractures with minimal trauma, their uncommon anatomical position and the other unusual radiographic features of these fractures have helped coin the term “atypical femoral fractures”. An increasing number of reports suggest association between bisphosphonates use and fractures of the subtrochanteric and proximal diaphyseal regions of the femur after minimal or no trauma. These drugs increase bone mineral density, reduce biochemical markers of bone turnover, and decrease the number of osteoporotic fractures at both vertebral and non-vertebral sites. Bisphosphonates remain the first-line therapy for the majority of patients with osteoporosis.
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