Hip fracture trends in the United States, 2002 to 2015.

An analysis of United States (US) Medicare claims data from 2002 to 2015 for women aged ≥ 65 years found that age-adjusted hip fracture rates for 2013, 2014, and 2015 were higher than projected, resulting in an estimated increase of more than 11,000 hip fractures. INTRODUCTION: Hip fractures are a major public health concern due to high morbidity, mortality, and healthcare expenses. Previous studies have reported a decrease in the annual incidence of hip fractures in the US beginning in 1995, coincident with the introduction of modern diagnostic tools and therapeutic agents for osteoporosis. In recent years, there has been less bone density testing and fewer prescriptions for osteoporosis treatments. The large osteoporosis treatment gap raises concern of possible adverse effects on hip fracture rates. METHODS: We assessed hip fracture incidence in the US to determine if the previous decline in hip fracture incidence continued. Using 2002 to 2015 Medicare Part A and Part B claims for women ≥ 65 years old, we calculated age-adjusted hip fracture rates, weighting to the 2014 population. RESULTS: We found that hip fracture rates declined each year from 2002 to 2012 and then plateaued at levels higher than projected for years 2013, 2014, and 2015. CONCLUSIONS: The plateau in age-adjusted hip fracture incidence rate resulted in more than 11,000 additional estimated hip fractures over the time periods 2013, 2014, and 2015. We recommend further study to assess all factors contributing to this remarkable change in hip fracture rate and to develop strategies to reduce the osteoporosis treatment gap.

Age assessment based on third molar mineralisation : An epidemiological-radiological study on a Central-European population.

PURPOSE: The method published in 1973 by Demirjian et al. to assess age based on the mineralisation stage of permanent teeth is standard practice in forensic and orthodontic diagnostics. From age 14 onwards, however, this method is only applicable to third molars. No current epidemiological data on third molar mineralisation are available for Caucasian Central-Europeans. Thus, a method for assessing age in this population based on third molar mineralisation is presented, taking into account possible topographic and gender-specific differences. METHODS: The study included 486 Caucasian Central-European orthodontic patients (9-24 years) with unaffected dental development. In an anonymized, randomized, and blinded manner, one orthopantomogram of each patient at either start, mid or end of treatment was visually analysed regarding the mineralisation stage of the third molars according to the method by Demirjian et al. Corresponding topographic and gender-specific point scores were determined and added to form a dental maturity score. Prediction equations for age assessment were derived by linear regression analysis with chronological age and checked for reliability within the study population. RESULTS: Mineralisation of the lower third molars was slower than mineralisation of the upper third molars, whereas no jaw-side-specific differences were detected. Gender-specific differences were relatively small, but girls reached mineralisation stage C earlier than boys, whereas boys showed an accelerated mineralisation between the ages of 15 and 16. CONCLUSIONS: The global equation generated by regression analysis (age = -1.103 + 0.268 × dental maturity score 18 + 28 + 38 + 48) is sufficiently accurate and reliable for clinical use. Age assessment only based on either maxilla or mandible also shows good prognostic reliability.

Provider Distribution Changes in Dual-Energy X-Ray Absorptiometry in the Medicare Population Over the Past Decade.

Both radiologists as well as nonimaging physicians perform dual-energy X-ray absorptiometry (DXA) imaging in the United States. This study aims to compare provider distribution between these physician groups on the Medicare population, which is the predominant age group of patients evaluated by this imaging procedure. Using the 2 relevant Current Procedural Terminology, Fourth Edition codes for DXA scans, source data were obtained from the CMS Physician Supplier Procedure Summary Master Files from 2003 through 2013. DXA scan procedure volumes for radiologists and nonradiologists on Medicare patients were tabulated. Utilization rates were calculated. From 2003 to 2013, the total number of DXA scans performed on Medicare patients decreased by 2%. However, over the same period, the number of scans performed by radiologists had increased by 25% over nonimaging specialists, whose utilization had declined by approximately the same amount. From 2003 to 2013, the rate of utilization of DXA scans in the Medicare fee-for-service population declined somewhat. However, radiologists continue to gain market share from other specialists and now predominate in this type of imaging by a substantial margin.

DXA Utilization Between 2006 and 2012 in Commercially Insured Younger Postmenopausal Women.

Reimbursement for dual-energy X-ray absorptiometry (DXA) scans in the outpatient setting has declined significantly since 2006. Research through 2011 has suggested reimbursement reductions for DXA scans have corresponded with an overall decreased utilization of DXA. This study updates utilization estimates for DXAs through 2012 in patients with commercial insurance and compares DXA rates before and after reimbursement changes. We evaluated DXA utilization for women aged 50-64 yr from Marketscan Commercial Claims and Encounter database between January 2006 and December 2012 based on CPT codes. We estimated utilization rates per 1000 person years (PY). We also used segmented regression analysis of monthly rates to evaluate the change in utilization rates after a proposed reimbursement reduction in July 2009. In women aged 50-64 yr, 451,656 DXAs were performed in 2006, a rate of 144 DXAs per 1000 PY. This rate increased to 149 DXAs per 1000 PY in 2009 before decreasing to 110 DXAs per 1000 PY or 667,982 scans in 2012. DXA utilization increased by 2.24 per 1000 PY until July 2009 then declined by 12.98 DXAs per 1000 persons, resulting in 37.5 DXAs per PY fewer performed in 2012 compared with 2006. Since July 2009 a significant decline in DXA utilization occurred in a younger postmenopausal commercially insured population. This decline corresponds with a time period of reductions in Medicare DXA reimbursement.

Assessment of bone quality and strength with new technologies.

PURPOSE OF REVIEW: To give an overview of advanced in-vivo imaging techniques for assessing bone quality beyond bone mineral density that have considerably advanced in recent years. RECENT FINDINGS: Quantitative computed tomography and finite element analysis improve fracture risk prediction at the spine, and help to better understand the pathophysiology of skeletal diseases and response to therapy by quantifying bone mineral density in different bone compartments, determining bone strength, and assessing bone geometry. With new high-resolution techniques, trabecular structure at the spine, forearm, and tibia, and cortical porosity at the forearm and tibia can be measured. Hip structure analysis and trabecular bone score have extended the usefulness of dual X-ray absorptiometry. SUMMARY: New advanced three-dimensional imaging techniques to quantify bone quality are mature and have proven to be complimentary methods to dual X-ray absorptiometry enhancing our understanding of bone metabolism and treatment.

Osteoporosis risk factor assessment and bone densitometry--current status and future trends.

INTRODUCTION: Osteoporosis and fragility fractures are problems which will increase in significance as the population of the elderly in many countries increases. The availability of bone mineral density (BMD) measurements, which can define osteoporosis, allows the implementation of effective therapeutic interventions to those at risk for fractures before they occur. Because of the increasing at-risk population and the relatively high cost of these measurements and interventions, a case-finding strategy to detecting osteoporosis has been widely recommended. This review highlights the approach to detecting and diagnosing osteoporosis. METHODS: A non-systematic review of English-language literature on the diagnosis and assessment of osteoporosis was conducted. RESULTS: Many risk factors have been found to be associated with osteoporosis and fractures. These risk factors may be utilised for case finding in deciding who should be evaluated for osteoporosis. Clinical self-assessment tools have been developed to identify women likely to have low BMD who might be recommended for BMD. Several techniques are available for BMD measurement, but the technique of choice for the diagnosis of osteoporosis is dual-energy X-ray absorptiometry (DXA) measured at the hip. BMD thresholds have been widely used to guide osteoporosis treatment. However, recent research has been directed at using risk factor assessment and self-assessment tools to derive medium-term fracture risk as a guide to therapeutic intervention. CONCLUSIONS: Proper selection of individuals for evaluation and treatment for osteoporosis would include risk factor assessment and appropriate BMD measurement to determine the risk of fracture and the need for intervention.