Charlie Norwood Veterans Affairs Medical Center, Augusta, Georgia, USA.
Department of Medicine, Division of Rheumatology, Medical College of Georgia, Augusta University, Augusta, Georgia, USA.
J Spinal Cord Med. 2023 Mar;46(2):317-325. doi: 10.1080/10790268.2022.2042658. Epub 2022 Mar 7.
Analyses of osteoporosis-related fractures in persons with Spinal Cord Injury or Disorder (SCID) using administrative data often exclude pathological fractures (International Classification of Diseases, Ninth Revision (ICD-9) codes 733.1x). We examined how often lower extremity "pathological" fractures were secondary to osteoporosis.
Retrospective case-control study, fiscal years 2005-2015.
Veterans Health Administration.
Veterans with SCID and an ICD-9 code for lower extremity fracture.
Clinical and SCID-related characteristics were compared in pathological and non-pathological fractures. A subset of Veterans with lower extremity fracture had data on fracture etiology from prior electronic health record (eHR) review. Of these, all with eHR-confirmed pathological fractures were considered cases. For each case, four unmatched controls with non-pathological fractures from this subset were randomly selected. Fracture etiology was compared between subsample cases and controls. We sought expert opinion from specialists who care for these fractures to understand their perspectives on what constitutes a pathological fracture and narrate our findings.
6,397 Veterans sustained 16,279 lower extremity fractures, including 314 (1.93%) pathological fractures in 264 Veterans. Ten of 13 (76.9%) cases of pathological fracture (76.9%) and 82.4% of non-pathological fractures were secondary to osteoporosis. Of the 19 experts surveyed, only two coded osteoporotic fractures as pathological.
Most pathological lower extremity fractures by ICD-9 codes in SCID are secondary to osteoporosis. Pathological fractures can be considered for inclusion in epidemiologic studies of osteoporosis in SCID when the risk-benefit profile for the study favors capturing all osteoporotic fractures at the expense of some misclassification.
利用行政数据对脊髓损伤或疾病（SCID）患者的骨质疏松性骨折进行分析时，通常会排除病理性骨折（国际疾病分类，第九版（ICD-9）代码 733.1x）。我们研究了下肢“病理性”骨折中有多少是由骨质疏松引起的。
回顾性病例对照研究，2005 年至 2015 年财政年度。
退伍军人健康管理局。
患有 SCID 且 ICD-9 代码为下肢骨折的退伍军人。
比较病理性和非病理性骨折患者的临床和 SCID 相关特征。下肢骨折退伍军人中有一部分人有来自电子病历（eHR）回顾的骨折病因数据。其中，所有经 eHR 确认的病理性骨折患者均被视为病例。对于每个病例，从该亚组中随机选择四个没有病理性骨折的非匹配对照。比较亚组病例和对照的骨折病因。我们向治疗这些骨折的专家征求意见，以了解他们对病理性骨折的看法，并叙述我们的发现。
6397 名退伍军人发生 16279 例下肢骨折，其中 264 名退伍军人中有 314 例（1.93%）为病理性骨折。13 例病理性骨折中有 10 例（76.9%）和 82.4%的非病理性骨折继发于骨质疏松症。在接受调查的 19 名专家中，只有 2 名将骨质疏松性骨折编码为病理性骨折。
根据 ICD-9 编码，SCID 中大多数下肢病理性骨折继发于骨质疏松症。当研究的风险效益概况有利于以一些分类错误为代价捕获所有骨质疏松性骨折时，可以考虑将病理性骨折纳入 SCID 骨质疏松症的流行病学研究中。
