Prevalence and risk of fracture diagnoses in women across the adult life span: a national cross-sectional study.

Chang PY, Saechao FS, Lee J, Haskell SG, Frayne SM, Lee JS. Prevalence and risk of fracture diagnoses in women across the adult life span: a national cross-sectional study. Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA. 2016 Nov 1; 27(11):3177-3186.

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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. INTRODUCTION: 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. METHODS: 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. RESULTS: 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). CONCLUSIONS: 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.