{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T15:01:01Z","timestamp":1785855661180,"version":"3.56.0"},"reference-count":21,"publisher":"Public Library of Science (PLoS)","issue":"9","license":[{"start":{"date-parts":[[2021,9,27]],"date-time":"2021-09-27T00:00:00Z","timestamp":1632700800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Radius Health, Inc."}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:p>The number of osteoporosis-related fractures in the United States is no longer declining. Existing risk-based assessment tools focus on long-term risk. Payers and prescribers need additional tools to identify patients at risk for imminent fracture. We developed and validated a predictive model for secondary osteoporosis fractures in the year following an index fracture using administrative medical and pharmacy claims from the Optum Research Database and Symphony Health, PatientSource. Patients \u226550 years with a case-qualifying fracture identified using a validated claims-based algorithm were included. Logistic regression models were created with binary outcome of a second fracture versus no second fracture within a year of index fracture, with the goal of predicting second fracture occurrence. In the Optum Research Database, 197,104 patients were identified with a case-qualifying fracture (43% commercial, 57% Medicare Advantage). Using Symphony data, 1,852,818 met the inclusion\/exclusion criteria. Average patient age was 70.09 (SD = 11.09) and 71.28 (SD = 14.24) years in the Optum Research Database and Symphony data, respectively. With the exception of history of falls (41.26% vs 18.74%) and opioid use (62.80% vs 46.78%), which were both higher in the Optum Research Database, the two populations were mostly comparable. A history of falls and steroid use, which were previously associated with increased fracture risk, continue to play an important role in secondary fractures. Conditions associated with bone health (liver disease), or those requiring medications that impact bone health (respiratory disease), and cardiovascular disease and stroke\u2014which may share etiology or risk factors with osteoporosis fractures\u2014were also predictors of imminent fractures. The model highlights the importance of assessment of patient characteristics beyond bone density, including patient comorbidities and concomitant medications associated with increased fall and fracture risk, in alignment with recently issued clinical guidelines for osteoporosis treatment.<\/jats:p>","DOI":"10.1371\/journal.pone.0257246","type":"journal-article","created":{"date-parts":[[2021,9,27]],"date-time":"2021-09-27T17:50:48Z","timestamp":1632765048000},"page":"e0257246","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":5,"title":["Development and validation of a one year predictive model for secondary fractures in osteoporosis"],"prefix":"10.1371","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6795-2677","authenticated-orcid":true,"given":"Setareh A.","family":"Williams","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susan L.","family":"Greenspan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tim","family":"Bancroft","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benjamin J.","family":"Chastek","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yamei","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard J.","family":"Weiss","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nick","family":"Pyrih","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hily","family":"Nichols","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jane A.","family":"Cauley","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2021,9,27]]},"reference":[{"issue":"3","key":"pone.0257246.ref001","doi-asserted-by":"crossref","first-page":"717","DOI":"10.1007\/s00198-017-4345-0","article-title":"Hip fracture trends in the United States, 2002 to 2015","volume":"29","author":"EM Lewiecki","year":"2018","journal-title":"Osteoporos Int"},{"issue":"7","key":"pone.0257246.ref002","doi-asserted-by":"crossref","first-page":"1299","DOI":"10.1007\/s00198-020-05334-y","article-title":"Osteoporotic fracture trends in a population of US managed care enrollees from 2007 to 2017","volume":"31","author":"EM Lewiecki","year":"2020","journal-title":"Osteoporos Int."},{"issue":"7","key":"pone.0257246.ref003","doi-asserted-by":"crossref","first-page":"e52","DOI":"10.2106\/JBJS.L.01781","article-title":"Declining rates of osteoporosis management following fragility fractures in the U.S., 2000 through 2009","volume":"96","author":"A Balasubramanian","year":"2014","journal-title":"J Bone Joint Surg Am"},{"key":"pone.0257246.ref004","unstructured":"CMS Centers for Medicare & Medicaid Services. Medicare 2018 Part C & D Star Ratings Technical Notes. Available from: https:\/\/www.cms.gov\/Medicare\/Prescription-Drug-Coverage\/PrescriptionDrugCovGenIn\/Downloads\/2018-Star-Ratings-Technical-Notes-2017_09_06.pdf. Accessed November 19, 2020."},{"issue":"4","key":"pone.0257246.ref005","doi-asserted-by":"crossref","first-page":"828","DOI":"10.1016\/j.bone.2010.12.021","article-title":"Cost burden of second fracture in the US health system","volume":"48","author":"X Song","year":"2011","journal-title":"Bone"},{"issue":"4","key":"pone.0257246.ref006","first-page":"461","article-title":"Prevalence and cost of subsequent fractures among U.S. patients with an incident fracture","volume":"23","author":"J Weaver","year":"2017","journal-title":"J Manag Care Spec Pharm"},{"issue":"5","key":"pone.0257246.ref007","first-page":"e142","article-title":"Economic Burden of Osteoporotic Fractures in US Managed Care Enrollees","volume":"26","author":"SA Williams","journal-title":"Am J Manag Care"},{"issue":"8","key":"pone.0257246.ref008","doi-asserted-by":"crossref","first-page":"1747","DOI":"10.1007\/s00198-018-4502-0","article-title":"Characteristics of Recurrent fractures","volume":"29","author":"JA Kanis","year":"2018","journal-title":"Osteoporos Int."},{"issue":"1","key":"pone.0257246.ref009","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1016\/j.bone.2013.05.002","article-title":"Comparison of different screening tools (FRAX\u00ae, OST, ORAI, OSIRIS, SCORE and age alone) to identify women with increased risk of fracture. A population-based prospective study","volume":"56","author":"KH Rubin","year":"2013","journal-title":"Bone"},{"issue":"10","key":"pone.0257246.ref010","doi-asserted-by":"crossref","first-page":"1798","DOI":"10.1002\/jbmr.3807","article-title":"The design and validation of a new algorithm to identify incident fractures in administrative claims data","volume":"34","author":"NC Wright","year":"2019","journal-title":"J Bone Miner Res"},{"issue":"Suppl 1","key":"pone.0257246.ref011","doi-asserted-by":"crossref","first-page":"1","DOI":"10.4158\/GL-2020-0524SUPPL","article-title":"American Association of Clinical Endocrinologists\/American College of Endocrinology Clinical Practice Guidelines for the Diagnosis and Treatment of Postmenopausal Osteoporosis-2020 Update.","volume":"26","author":"PM Camacho","year":"2020","journal-title":"Endocr Pract"},{"issue":"6","key":"pone.0257246.ref012","doi-asserted-by":"crossref","first-page":"676","DOI":"10.1093\/aje\/kwq433","article-title":"Updating and validating the Charlson comorbidity index and score for risk adjustment in hospital discharge abstracts using data from 6 countries","volume":"173","author":"H Quan","year":"2011","journal-title":"Am J Epidemiol"},{"issue":"8","key":"pone.0257246.ref013","doi-asserted-by":"crossref","first-page":"774","DOI":"10.1016\/S0895-4356(01)00341-9","article-title":"Internal validation of predictive models: efficiency of some procedures for logistic regression analysis.","volume":"54","author":"EW Steyerberg","year":"2001","journal-title":"J Clin Epidemiol"},{"issue":"1","key":"pone.0257246.ref014","doi-asserted-by":"crossref","first-page":"36","DOI":"10.1002\/jbmr.3877","article-title":"Secondary Fracture Prevention: Consensus Clinical Recommendations from a Multistakeholder Coalition","volume":"35","author":"RB Conley","year":"2020","journal-title":"J Bone Miner Res"},{"key":"pone.0257246.ref015","article-title":"TRIPOD reporting guidelines for diagnostic and prognostic studies","author":"RE Patzer","year":"2021","journal-title":"JAMA Surg"},{"key":"pone.0257246.ref016","unstructured":"Pharmacist\u2019s Letter\/Prescriber\u2019s Letter. Potentially Harmful Drugs in the Elderly: Beers List. June 2012. Available from: http:\/\/medischebijsluiter.nl\/wp-content\/uploads\/2017\/02\/Beers-Criteria-Literature.pdf. Accessed November 19, 2020."},{"issue":"6","key":"pone.0257246.ref017","doi-asserted-by":"crossref","first-page":"589","DOI":"10.1093\/aje\/kwh080","article-title":"Metacarpal Cortical Area and Risk of Coronary Heart Disease: The Framingham Study","volume":"159","author":"EJ Samelson","year":"2004","journal-title":"Am J Epidemiol"},{"key":"pone.0257246.ref018","unstructured":"Centre for Metabolic Bone Diseases. FRAX Fracture Risk Assessment Tool. Available from: https:\/\/www.sheffield.ac.uk\/FRAX\/. Accessed November 19, 2020."},{"issue":"4","key":"pone.0257246.ref019","doi-asserted-by":"crossref","first-page":"385","DOI":"10.1007\/s00198-007-0543-5","article-title":"FRAX and the assessment of fracture probability in men and women from the UK","volume":"19","author":"JA Kanis","year":"2008","journal-title":"Osteoporos Int"},{"key":"pone.0257246.ref020","doi-asserted-by":"crossref","first-page":"267","DOI":"10.1016\/j.bone.2015.11.021","article-title":"Proportion of osteoporotic women remaining at risk for fracture despite adherence to oral bisphosphonates","volume":"83","author":"EA Imel","year":"2016","journal-title":"Bone"},{"issue":"1","key":"pone.0257246.ref021","doi-asserted-by":"crossref","first-page":"175","DOI":"10.1080\/21556660.2019.1677674","article-title":"Impact of fractures on quality of life in patients with osteoporosis: a US cross-sectional survey","volume":"8","author":"T Gold","year":"2019","journal-title":"J Drug Assess"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0257246","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,9,27]],"date-time":"2021-09-27T17:51:15Z","timestamp":1632765075000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0257246"}},"subtitle":[],"editor":[{"given":"Robert Daniel","family":"Blank","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2021,9,27]]},"references-count":21,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2021,9,27]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0257246","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,9,27]]}}}