Information regarding the SCID etiology, date of onset, level of injury, completeness of injury and the Veteran’s healthcare can be found in these archival databases for Veterans with SCID. Both the SCD Registry and SCIDO are historical administrative databases archived in the VHA Enterprise virtual environment that were used to track the population of Veterans with SCID followed by each SCID Center. The ARC list was also linked to the Veterans Affairs (VA) Spinal Cord Dysfunction (SCD) Registry and/or the SCID Outcomes Database (SCIDO) to determine SCID-specific variables. The list of those with SCID was combined with health care utilization and demographic data from the VHA’s Corporate Data Warehouse. ARC is a cumulative list of Veterans who have ever received health care from a VHA facility. We identified Veterans with SCID from the 2016 Veterans Health Administration (VHA) allocation resource center (ARC) list using ICD-9 diagnosis codes for a SCID and treatment in either a spinal cord injury (SCI) bed section or outpatient clinic. Moreover, the interpretation of what constitutes a pathological fracture to physicians caring for patients with SCID who sustain a fracture was explored by surveying an expert panel. We hypothesized that some Veterans with SCID with a diagnosis of a lower extremity pathological fracture identified from administrative databases would have no apparent metastatic cancer to bone or other localized disorder of bone. However, it is not known whether these fractures are indeed osteoporotic, and therefore should be included, as provider patterns for allocation of ICD-9 diagnosis codes in the setting of osteoporotic fractures in patients with SCID are poorly characterized. 7–10 Although the rationale for this is often not explicitly stated, the implication is that a pathological fracture is secondary to a localized process (such as malignancy) rather than osteoporosis.
6Įpidemiological studies of osteoporosis utilizing administrative data in persons with spinal cord injury or disorder (SCID) who sustain lower extremity fractures have also commonly excluded pathological fractures. Medicare beneficiaries, it has been suggested that excluding persons with pathological fractures, particularly vertebral fractures, in analyses relying solely on administrative claims data will underestimate the burden of osteoporotic fractures. In epidemiological studies of osteoporosis in the able-bodied population, such fractures are often not included. However, there is variability in how providers use the International Classification of Diseases, Ninth Revision (ICD-9) pathological fracture diagnosis codes in practice. Pathological fractures are defined as fractures “of a bone weakened by disease.” 1 Accordingly, by definition, pathological fractures can be secondary to localized pathologies such as cancer, bone tumors, or osteomyelitis or systemic disorders such as osteoporosis.
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