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Reply to: Effect of pharmacological treatment of osteoporosis in the prevention of pathological vertebral fractures
Bone 59 (2014) 150
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Bone journal homepage: www.elsevier.com/locate/bone
Reply to Letter to the Editor Reply to: Effect of pharmacological treatment of osteoporosis in the prevention of pathological vertebral fractures
To the Editor: Pellegrino et al. report a 39% decrease (no time period stated) and a 48% decrease between 2008 and 2010 in the rate of hospital admissions in the United States for patients with diagnoses of pathological vertebral fractures (ICD-9-CM 733.13) and osteoporosis (ICD-9-CM 733.00) [1]. They attribute the 48% decline to the introduction of intravenous bisphosphonates in 2006 and 2007 that was reported in our article on trends in the use of oral and intravenous bisphosphonates [2]. Data provided to us by staff of the National Hospital Discharge Survey [3] indicate a 47% decline (from 9.24 to 4.87 per 100,000 population) in the rate of hospitalizations between 2008 and 2010 for patients with pathological vertebral fractures as the first listed discharge diagnosis and osteoporosis among the other six captured diagnoses. When 15 discharge diagnoses per hospitalization were captured beginning in 2010, the rate was 6.82 per 100,000 population in 2010 [3]. Although the per cent decline for the captured seven diagnoses are nearly the same in the letter compared with the NHDS staff's data, the hospitalization rates presented separately in the graph accompanying the letter for pathological vertebral fractures (about 18 per 100,000 population in 2008 and 15 per 100,000 in 2010) and osteoporosis (about 9 per 100,000 population in 2008 and 5 per 100,000 in 2010) are not consistent with the NHDS staff's rates. Furthermore, the graph shows a substantial decline in the rate of hospitalizations for pathological vertebral fractures between 1996 and 2001 followed by an increase through 2003 that are not specifically mentioned or explained. Besides the marketing of intravenous bisphosphonates, the decline in hospitalizations of vertebral fractures in patients with osteoporosis may be associated with other factors that increase bone density (oral
8756-3282/$ – see front matter. Published by Elsevier Inc. http://dx.doi.org/10.1016/j.bone.2013.11.003
bisphosphonates, calcium, vitamin D, increased weight, hormone therapy) [4,5]. Also, since osteoporotic vertebral fractures usually occur spontaneously or as the result of very minimal trauma, are often asymptomatic or may cause temporary pain, and can be managed with pain medicine [4], coincidental with the economic recession that began in 2008, patients may have sought less medical care for this condition. To determine if intravenous bisphosphonate administration led to fewer pathological vertebral fracture hospitalizations in patients with osteoporosis between 2008 and 2010, a study would be needed that compares patients hospitalized with those not hospitalized for various factors including intravenous bisphosphonate use. Also, since the graph shows variation in rates over the 15-year period, it would be informative to determine if the decline is sustained.
References [1] Pellegrino P, Carnovale C, Perrone V, Pozzi M, Salvati D, Gentili M, et al. Effect of pharmacological treatment of osteoporosis in the prevention of pathological vertebral fractures. Bone 2014;59:148–9. [2] Wysowski DK, Greene P. Trends in osteoporosis treatment with oral and intravenous bisphosphonates in the United States, 2002–2012. Bone 2013;57:423–8. [3] Centers for Disease Control and Prevention, National Center for Health Statistics, National Hospital Discharge Survey, 2006–2010 data files. Special data runs. [4] Cummings SR. Epidemiology of osteoporosis and osteoporotic fractures. Epidemiol Rev 1985;7:178–208. [5] Update on osteoporosis treatment: should you stay on bisphosphonate drugs long-term? Harvard Women's Health Watch, Harvard Health Publications; August 2012 6.
Diane K. Wysowski Office of Surveillance and Epidemiology, Food and Drug Administration, Silver Spring, MD 20993, USA 1 November 2013
Contents lists available at ScienceDirect
Bone journal homepage: www.elsevier.com/locate/bone
Reply to Letter to the Editor Reply to: Effect of pharmacological treatment of osteoporosis in the prevention of pathological vertebral fractures
To the Editor: Pellegrino et al. report a 39% decrease (no time period stated) and a 48% decrease between 2008 and 2010 in the rate of hospital admissions in the United States for patients with diagnoses of pathological vertebral fractures (ICD-9-CM 733.13) and osteoporosis (ICD-9-CM 733.00) [1]. They attribute the 48% decline to the introduction of intravenous bisphosphonates in 2006 and 2007 that was reported in our article on trends in the use of oral and intravenous bisphosphonates [2]. Data provided to us by staff of the National Hospital Discharge Survey [3] indicate a 47% decline (from 9.24 to 4.87 per 100,000 population) in the rate of hospitalizations between 2008 and 2010 for patients with pathological vertebral fractures as the first listed discharge diagnosis and osteoporosis among the other six captured diagnoses. When 15 discharge diagnoses per hospitalization were captured beginning in 2010, the rate was 6.82 per 100,000 population in 2010 [3]. Although the per cent decline for the captured seven diagnoses are nearly the same in the letter compared with the NHDS staff's data, the hospitalization rates presented separately in the graph accompanying the letter for pathological vertebral fractures (about 18 per 100,000 population in 2008 and 15 per 100,000 in 2010) and osteoporosis (about 9 per 100,000 population in 2008 and 5 per 100,000 in 2010) are not consistent with the NHDS staff's rates. Furthermore, the graph shows a substantial decline in the rate of hospitalizations for pathological vertebral fractures between 1996 and 2001 followed by an increase through 2003 that are not specifically mentioned or explained. Besides the marketing of intravenous bisphosphonates, the decline in hospitalizations of vertebral fractures in patients with osteoporosis may be associated with other factors that increase bone density (oral
8756-3282/$ – see front matter. Published by Elsevier Inc. http://dx.doi.org/10.1016/j.bone.2013.11.003
bisphosphonates, calcium, vitamin D, increased weight, hormone therapy) [4,5]. Also, since osteoporotic vertebral fractures usually occur spontaneously or as the result of very minimal trauma, are often asymptomatic or may cause temporary pain, and can be managed with pain medicine [4], coincidental with the economic recession that began in 2008, patients may have sought less medical care for this condition. To determine if intravenous bisphosphonate administration led to fewer pathological vertebral fracture hospitalizations in patients with osteoporosis between 2008 and 2010, a study would be needed that compares patients hospitalized with those not hospitalized for various factors including intravenous bisphosphonate use. Also, since the graph shows variation in rates over the 15-year period, it would be informative to determine if the decline is sustained.
References [1] Pellegrino P, Carnovale C, Perrone V, Pozzi M, Salvati D, Gentili M, et al. Effect of pharmacological treatment of osteoporosis in the prevention of pathological vertebral fractures. Bone 2014;59:148–9. [2] Wysowski DK, Greene P. Trends in osteoporosis treatment with oral and intravenous bisphosphonates in the United States, 2002–2012. Bone 2013;57:423–8. [3] Centers for Disease Control and Prevention, National Center for Health Statistics, National Hospital Discharge Survey, 2006–2010 data files. Special data runs. [4] Cummings SR. Epidemiology of osteoporosis and osteoporotic fractures. Epidemiol Rev 1985;7:178–208. [5] Update on osteoporosis treatment: should you stay on bisphosphonate drugs long-term? Harvard Women's Health Watch, Harvard Health Publications; August 2012 6.
Diane K. Wysowski Office of Surveillance and Epidemiology, Food and Drug Administration, Silver Spring, MD 20993, USA 1 November 2013