Article Title: Femur Neck Bone Mineral Density and Fracture Risk by Age, Sex, and Race

Article title: Femur neck bone mineral density and fracture risk by age, sex, and race or Hispanic origin in older adults from NHANES III Journal: Osteoporosis International Authors: Looker, AC ([email protected]) 5 Appendix 1 (Online Resource 1) Fracture case identification from Medicare records

10 The following codes were used to identify hip, medically-diagnosed spine, radius and humerus fracture cases from Medicare records based on methods developed by Ray et al [22]) Taylor et al [23] and Curtis et al [24]. Cases were defined using relevant International Classification of Disease (ICD), Healthcare Common Procedure Coding System ( HCPCS) or Current Procedural Terminology (CPT) codes for the years 1991-2007 [25, 26]

15 I. Hip fracture: A. Medpar inpatient hospital/skilled nursing facility file: ICD-9 diagnosis code for fracture of hip (820.xx) or pathological fracture of hip (733.14).

B. Carrier file: ICD-9 diagnosis of fracture of hip (820.xx) or pathological fracture of hip (733.14) 20 PLUS: a. HCPCS /CPT code for hip fracture reduction (27125--27131; 27230--27248); OR b. HCPCS/CPT code for casting/splinting of hip (29005--29046; 29305--29365; 29799).

25 C. Outpatient file: 1. ICD-9 diagnosis code of fracture of hip (812.xx) or pathological fracture of hip (733.14) PLUS: a. HCPCS/CPT code for hip fracture reduction (27125--27148); OR b. HCPCS/CPT code for casting/splinting of hip (29005--29046; 29305--29365; 29799). 30 OR 2. ICD surgical procedure code for hip ((81.40,81.51,81.52,81.53,81.59,78.55,79.05,79.15, 79.25, 79.35,79.45,79.55,79.65) PLUS: a. ICD-9-CM code for fracture of hip (820.xx) or pathological fracture of hip (733.14) OR b HCPCS/CPT codes for hip fracture reduction procedure, or casting/splinting of hip shown in 35 Part I.C.1.a- b.

II. Humerus fracture: A. Medpar inpatient hospital/skilled nursing facility file: ICD 9 diagnosis code for fracture of humerus (812.xx) or pathological fracture of humerus (733.11). 40 B. Carrier file: ICD diagnosis of fracture of humerus (812.xx) or pathological fracture of humerus (733.11) PLUS: a. HCPCS/CPT code for humerus fracture reduction (23600--23680; 24500--24579); OR b. HCPCS/CPT code for casting/splinting of humerus (29035--29065; 29105; 29799); OR c. HCPCS/CPT code for fracture reduction procedure at distal humerus and/or proximal ulna, radius (24580--24588).

C. Outpatient file: 5 1. ICD diagnosis of fracture of humerus (812.xx) or pathological fracture of humerus (733.11) PLUS: a. HCPCS/CPT code for humerus fracture reduction (23600--23680; 24500--24579); OR b. HCPCS/CPT code for casting/splinting of humerus (29035--29065; 29105; 29799); OR 10 c. HCPCS/CPT code for fracture reduction procedure at distal humerus and/or proximal ulna, radius (24580--24588). OR 2. ICD-9 surgical procedure code for humerus (78.52, 79.01, 79.11, 79.21, 79.31, 79.61) PLUS: 15 a. ICD-9 diagnosis code for humerus fracture (812.xx) or pathological fracture of humerus (733.11) OR b. HCPCS/ CPT code for humerus fracture reduction procedure, humerus casting or splinting, or proximal radius/distal humerus fracture reduction procedures shown in Part II.C.a-c.

III. Radius fracture: 20 A. Medpar Inpatient Hospital file/Skilled Nursing facility file: ICD-9 diagnosis code for: a. fracture of forearm (813.xx), pathological fracture of forearm (733.12), or wrist not otherwise specified (NOS) (814.00, 814.10); OR b. carpal fracture (ICD 814.01--814.09; 814.11--814.19) PLUS ICD surgical procedure code for radius/ulna (78.53; 79.02, 79.12, 79.22, 79.32, 79.62). 25 B. Carrier file: 1. ICD diagnosis of fracture of forearm (813.xx), pathological fracture of forearm (733.12), or wrist NOS (814.00, 814.10) PLUS: a. HCPCS/CPT code for forearm fracture reduction (24620--24685; 25500—25575;25600— 30 25652); OR b. HCPCS code for casting/splinting of forearm (29065--29085; 29105--29126; 29799); OR c. HCPCS code for fracture reduction procedure at distal humerus and/or proximal ulna, radius (24580--24588). OR 35 2. ICD diagnosis of carpal fracture (814.01--814.09 or 814.11--814.19) PLUS HCPCS/CPT code for forearm fracture reduction shown in Part III.B.1.a or Part III.B.1.c.

C. Outpatient file: 1. ICD diagnosis of fracture of forearm (813.xx), pathological fracture of forearm (733.12), or wrist 40 NOS (814.00, 814.10) PLUS: a. HCPCS/CPT code for forearm fracture reduction (24620--24685; 25500—25575;25600— 25652); OR b. HCPCS code for casting/splinting of forearm (29065--29085; 29105--29126; 29799); OR c. HCPCS code for fracture reduction procedure at distal humerus and/or proximal ulna, radius (24580--24588). OR 5 2. ICD diagnosis code for carpal fracture (814.01--814.09 or 814.11--814.19) PLUS a. HCPCS code for forearm fracture reduction shown in Part III.C.1.a or Part III.C.1.c; OR b. ICD surgical procedure code for radius/ulna (78.53, 79.02, 79.12, 79.22, 79.32, 79.62). OR 3. ICD surgical procedure code for forearm PLUS: 10 a. ICD diagnosis code for forearm fracture or wrist NOS shown in Part III.C.1; OR b. HCPCS/ CPT forearm fracture reduction procedure, forearm cast or proximal radius/distal humerus fracture reduction procedure shown in Part III.C.1a-c.

IV. Spine fracture: 15 A. Medpar Inpatient Hospital file/Skilled Nursing facility file: ICD-9 diagnosis code (primary only) for fracture of the dorsal thoracic vertebrae (805.2), lumbar vertebrae (805.4), unspecified vertebral location (805.8) or pathological fracture of vertebrae (733.13).

B. Carrier file: ICD-9 diagnosis code (primary only) for fracture of the dorsal thoracic vertebrae 20 (805.2), lumbar vertebrae (805.4) or unspecified location (805.8) or pathological fracture of vertebrae (733.13) PLUS: a. HCPCS/CPT code for treatment of vertebral fracture (22305--22328), percutaneous vertebroplasty (22520-22522), or radiological supervision of percutaneous vertebroplasty (76012-76013) OR 25 b. spine imaging code (72010-72159, 72240-72295) and physician visit code (99xxx) within 10 days of each other.

C. Outpatient file: Same criteria as used for records from Carrier File shown in Part IV.B.a-b.

30 V. Exclusions for care of previous fracture or other bone diseases, neoplasm and hip arthroplasty for arthritis:

1. Concurrent ICD-9 code indicating care for a previous fracture or other bone disease: late effects of fracture (905.1, 905.2, 905.3, 905.4,905.5), implant complication (codes 996.4, 996.6, 996.7, E878.1), bone cyst (733.2), injury other nonspecified (959) aseptic necrosis (733.4), malunion of bone (773.8), 35 other disorders of bone or cartilage (733.9), malignant neoplasm of bone or unspecified site (170, 170.6, 199.1) or fracture follow-up care (V540, V664, V670, V674). For spine fracture cases, additional exclusions for neoplasms were made (140-165, 170-176,179-208, 228.09,238,238.6,239.2).

2. Concurrent ICD codes indicating hip arthroplasty (81.51. 81.52, 81.53, 81.59) and arthritis (715).