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In Canada and other countries, osteoporosis is monitored as part of chronic disease population surveillance programs. Although fractures are the principal manifestation of osteoporosis, very few algorithms are available to identify individuals at high risk of osteoporotic fractures in current surveillance systems. The objective of this study was to derive and validate predictive models to accurately identify individuals at high risk of osteoporotic fracture using information available in healthcare administrative data. More than 270,000 men and women aged ≥66 years were randomly selected from the Quebec Integrated Chronic Disease Surveillance System. Selected individuals were followed between fiscal years 2006-2007 and 2015-2016. Models were constructed for prediction of hip/femur and major osteoporotic fractures for follow-up periods of 5 and 10 years. A total of 62 potential predictors measurable in healthcare administrative databases were identified. Predictor selection was performed using a manual backward algorithm. The predictive performance of the final models was assessed using measures of discrimination, calibration, and overall performance. Between 20 and 25 predictors were retained in the final prediction models (eg, age, sex, social deprivation index, most of the major and minor risk factors for osteoporosis, diabetes, Parkinson's disease, cognitive impairment, anemia, anxio-depressive disorders). Discrimination of the final models was higher for the prediction of hip/femur fracture than major osteoporotic fracture and higher for prediction for a 5-year than a 10-year period (hip/femur fracture for 5 years: c-index = 0.77; major osteoporotic fracture for 5 years: c-index = 0.71; hip/femur fracture for 10 years: c-index = 0.73; major osteoporotic fracture for 10 years: c-index = 0.68). The predicted probabilities globally agreed with the observed probabilities. In conclusion, the derived models had adequate predictive performance in internal validation. As a final step, these models should be validated in an external cohort and used to develop indicators for surveillance of osteoporosis. © 2021 American Society for Bone and Mineral Research (ASBMR)., (© 2021 American Society for Bone and Mineral Research (ASBMR).)

Background: Worldwide, 1.3 million patients sustain a hip fracture every year. In Canada, 23 621 patients over 60 have been admitted with a hip fracture in 2003. Few authors have yet investigated the full postoperative trajectory of patients admitted for a hip fracture, in terms of orientation., Hypothesis: Most geriatric patients undergoing surgery for a hip fracture will not be able to return to their original residence at one-year of follow-up., Objective: To characterize the full one-year postoperative trajectory of patients admitted for a hip fracture, in terms of orientation., Patients and Methods: This is a prospective observational cohort study of geriatric patients undergoing surgery for a hip fracture from 2011 to 2017 in an academic center. A total of 254 patients were enrolled in this cohort. Demographic data and scores were collected throughout the hospitalisation. Patients' residences were assessed pre-fracture and at 1, 3, 6 and 12-month post-hospitalisation., Results: Most patients evolved in one of the following trajectories at one-year; (1) 30% (n=63) went back at home, (2) 11% (n=22) went back to a senior residence, (3) 16% (n=36) needed rehabillitation, (4) 13% (n=28) were discharged to a different location than prior to admission and (5) 18% (n=37) were deceased. Patients evolving in trajectory 1 were younger (mean, 80.8±11.1, p<0.0001). Patients evolving in trajectory 5 had lower MNA 1 scores (mean, 19.9±5.2, p.<0.0001) and lower MMSE 2 scores (mean, 16.0±10.9, p<0.0001). The delay between discharge from the attending staff and real departure from the hospital was correlated to low MNA scores (-0.35627, p<0.0001), low MMSE scores (-0.35910, p=0.0004) and associated with the need for a rehabilitation center (trajectory 3) (mean, 2.67±4.36 days, p=0.0002)., Discussion: The postoperative evolution of geriatric patients with a hip fracture will continue to worsen due to the aging of the population. However, this study highlights important issues such as nutritional assessment, cognitive disorders and access to rehabilitation centers., Level of Evidence: II, prospective cohort study., (Copyright © 2019 Elsevier Masson SAS. All rights reserved.)

Age-standardized rates of hip fracture in Canada declined during the period 1985 to 2005. We investigated whether this incidence pattern is explained by period effects, cohort effects, or both. All hospitalizations during the study period with primary diagnosis of hip fracture were identified. Age- and sex-specific hip fracture rates were calculated for nineteen 5-year age groups and four 5-year calendar periods, resulting in 20 birth cohorts. The effect of age, calendar period, and birth cohort on hip fracture rates was assessed using age-period-cohort models as proposed by Clayton and Schiffers. From 1985 to 2005, a total of 570,872 hospitalizations for hip fracture were identified. Age-standardized rates for hip fracture have progressively declined for females and males. The annual linear decrease in rates per 5-year period were 12% for females and 7% for males (both p < 0.0001). Significant birth cohort effects were also observed for both sexes (p < 0.0001). Cohorts born before 1950 had a higher risk of hip fracture, whereas those born after 1954 had a lower risk. After adjusting for age and constant annual linear change (drift term common to both period and cohort effects), we observed a significant nonlinear birth cohort effect for males (p = 0.0126) but not for females (p = 0.9960). In contrast, the nonlinear period effect, after adjustment for age and drift term, was significant for females (p = 0.0373) but not for males (p = 0.2515). For males, we observed no additional nonlinear period effect after adjusting for age and birth cohort, whereas for females, we observed no additional nonlinear birth cohort effect after adjusting for age and period. Although hip fracture rates decreased in both sexes, different factors may explain these changes. In addition to the constant annual linear decrease, nonlinear birth cohort effects were identified for males, and calendar period effects were identified for females as possible explanations., Competing Interests: All authors state that they have no conflicts of interest. All authors had no restrictions on access to raw data or statistical analyses., (Copyright © 2013 American Society for Bone and Mineral Research.)

Objective: To determine the validity of the diagnostic algorithms for osteoporosis and fractures in administrative data., Study Design and Setting: A systematic search was conducted to identify studies that reported the validity of a diagnostic algorithm for osteoporosis and/or fractures using administrative data., Results: Twelve studies were reviewed. The validity of the diagnosis of osteoporosis in administrative data was fair when at least 3 years of data from hospital and physician visit claims were used (area under the receiver operating characteristic [ROC] curve [AUC]=0.70) or when pharmacy data were used (with or without the use of hospital and physician visit claims data, AUC>0.70). Nonetheless, the positive predictive values (PPVs) were low (<0.60). There was good evidence to support the use of hospital data to identify hip fractures (sensitivity: 69-97%; PPV: 63-96%) and the addition of physician claims diagnostic and procedural codes to hospitalization diagnostic codes improved these characteristics (sensitivity: 83-97%; PPV: 86-98%). Vertebral fractures were difficult to identify using administrative data. There was some evidence to support the use of administrative data to define other fractures that do not require hospitalization., Conclusions: Administrative data can be used to identify hip fractures. Existing diagnostic algorithms to identify osteoporosis and vertebral fractures in administrative data are suboptimal., (Copyright © 2013 Elsevier Inc. All rights reserved.)

Context: Hip fractures are a public health concern because they are associated with significant morbidity, excess mortality, and the majority of the costs directly attributable to osteoporosis., Objective: To examine trends in hip fracture rates in Canada., Design, Setting, and Patients: Ecologic trend study using nationwide hospitalization data for 1985 to 2005 from a database at the Canadian Institute for Health Information. Data for all patients with a hospitalization for which the primary reason was a hip fracture (570,872 hospitalizations) were analyzed., Main Outcome Measures: Age-specific and age-standardized hip fracture rates., Results: There was a decrease in age-specific hip fracture rates (all P for trend <.001). Over the 21-year period of the study, age-adjusted hip fracture rates decreased by 31.8% in females (from 118.6 to 80.9 fractures per 100,000 person-years) and by 25.0% in males (from 68.2 to 51.1 fractures per 100,000 person-years). Joinpoint regression analysis identified a change in the linear slope around 1996. For the overall population, the average age-adjusted annual percentage decrease in hip fracture rates was 1.2% (95% confidence interval, 1.0%-1.3%) per year from 1985 to 1996 and 2.4% (95% confidence interval, 2.1%-2.6%) per year from 1996 to 2005 (P < .001 for difference in slopes). Similar changes were seen in both females and males with greater slope reductions after 1996 (P < .001 for difference in slopes for each sex)., Conclusions: Age-standardized rates of hip fracture have steadily declined in Canada since 1985 and more rapidly during the later study period. The factors primarily responsible for the earlier reduction in hip fractures are unknown.