Appendix. TABLE E-1 Study Variables and Associated ICD-9-CM, HCPCS, and CPT Codes. Codes. (1) Fracture locations
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1 Page 1 Appendix TABLE E-1 Study Variables and Associated ICD-9-CM, HCPCS, and CPT Codes (1) Fracture locations Vertebral fracture Codes ICD-9-CM Diagnosis codes: , 805.xx, 806.xx ICD-9-CM Procedure codes: 81.65, HCPCS codes: S2360 CPT codes: 22305, 22310, 22318, 22319, 22520, 22521, 22523, 22524, 27200, Hip, pelvic, femoral fracture ICD-9-CM Diagnosis codes: , , , , , 808.xx, 820.xx, 821.xx ICD-9-CM Procedure codes: 79.05, 79.15, 79.25, 79.35, CPT codes: 27193, 27194, 27215, 27216, 27217, 27218, 27220, 27222, 27226, 27227, 27228, 27230, 27232, 27235, 27236, 27238, 27240, 27244, 27245, 27246, 27248, 27254, 27267, 27268, 27269, 27500, 27501, 27502, 27503, 27506, 27507, 27508, 27509, 27510, 27511, 27513, Other nonvertebral fracture Upper-limb fracture Lower-limb fracture Upper-body fracture ICD-9-CM Diagnosis codes: , , 812.xx, 813.xx, 814.xx, 815.xx, 818.xx ICD-9-CM Procedure codes: 79.01, 79.02, 79.03, 79.11, 79.12, 79.13, 79.21, 79.22, 79.23, 79.31, 79.32, 79.33, 79.61, 79.62, CPT codes: 23600, 23605, 23615, 23616, 23620, 23625, 23630, 23665, 23670, 23675, 23680, 24500, 24505, 24515, 24516, 24530, 24535, 24538, 24545, 24546, 24560, 24565, 24566, 24575, 24576, 24577, 24579, 24582, 24620, 24635, 24650, 24655, 24665, 24666, 24670, 24675, 24685, 25500, 25505, 25515, 25520, 25525, 25526, 25530, 25535, 25545, 25560, 25565, 25574, 25575, 25600, 25605, 25606, 25607, 25608, 25609, 25622, 25624, 25628, 25630, 25635, 25645, 25650, 25651, 25652, 25680, 25685, 26600, 26605, 26607, 26608, ICD-9-CM Diagnosis codes: , , , 822.x, 823.x, 824.x, 825.x, 827.x ICD-9-CM Procedure codes: 79.06, 79.07, 79.16, 79.17, 79.26, 79.27, 79.36, 79.37, 79.66, CPT codes: 27520, 27524, 27530, 27532, 27535, 27536, 27538, 27540, 27750, 27752, 27756, 27758, 27759, 27760, 27762, 27766, 27767, 27768, 27769, 27780, 27781, 27784, 27786, 27788, 27792, 27808, 27810, 27814, 27816, 27818, 27822, 27823, 27824, 27825, 27826, 27827, 27828, 28400, 28405, 28406, 28415, 28420, 28430, 28435, 28436, 28445, 28450, 28455, 28456, 28465, 28470, 28475, 28476, 28485, 29850, 29851, 29855, ICD-9-CM Diagnosis codes: 807.0x-807.4x, 809.xx, 810.xx, 811.xx, 819.xx CPT codes: 21800, 21805, 21810, 21820, 21825, 23500, 23505, 23515, 23570, 23575, Unspecified nonvertebral fracture ICD-9-CM Diagnosis codes: , , , 828.x (2) Fractures with trauma codes ICD-9-CM Diagnosis codes: E800-E848, E916-E919, E E928.9, E929.0-E929.1, E953, E957-E959, E960-E979, E988- E989, E999 (3) BMD assessments CPT codes: 76499, 76977, 77078, 77080, 77081, 77083, 77085, 77086, 78350, 78351
2 Page 2 Medications Drug class (1) Paget disease medication prescriptions filled Oral bisphosphonates (2) Osteoporosis medication prescriptions filled Anabolics Antiresorptives Oral bisphosphonates Injectable bisphosphonates Other injectable antiresorptives Other antiresorptives (3) Concomitant medication prescriptions filled Other antiresorptives Glucocorticoids Anticonvulsant therapies Generic name (dosage, if applicable) Risedronate (30 mg) Alendronate (40 mg) Etidronate (200 or 400 mg) Pamidronate disodium (30 mg) Tiludronate (400 mg) Teriparatide Alendronate (5 mg or 10 mg daily, 35 or 70 mg weekly) Risedronate (5 mg daily, 35 mg weekly, 75 or 150 mg monthly) Ibandronate (150 mg monthly) Alendronate sodium/cholecalciferol Risedronate sodium/calcium carbonate Zoledronic acid Ibandronate sodium/isopropyl alcohol Ibandronate sodium (3 ml) Ibandronate intravenous (IV) Pamidronate sodium Denosumab Raloxifene (60 mg daily) Calcitonin (200 IU/mL daily nasally) Tamoxifen (10 or 20 mg) Triamcinolone Methylprednisolone Betamethasone Hydrocortisone Prednisone Prednisolone Budesonide Dexamethasone Cortisone Perampanel Phenytoin Mephobarbital Phenobarbital Primidone Clobazam Diazepam Lorazepam Felbamate Acetazolamide Zonisamide Topiramate Rufinamide Oxcarbazepine Eslicarbazepine Carbamazepine Divalproex sodium Valproic acid Pregabalin
3 Page 3 Vigabatrin Tiagabine Phenytoin Ethotoin Fosphenytoin Lacosamide Ezogabine Paramethadione Trimethadione Levetiracetam Ethosuximide Methsuximide Lamotrigine
4 Page 4 TABLE E-2 Propensity-Score Matched Adjusted Baseline Demographic and Clinical Characteristics of Patients Exposed and Unexposed to OP MS with 12 Months of Post-Index Continuous Medicare Enrollment (Parts A and B) in the Michigan Medicare Population* Baseline Characteristic Exposed Cohort (N = 904) Unexposed Cohort (N = 904) P Value Standardized Difference Age (yr) 74.9 ± ± Distribution by age group <65 yr 159 (17.6%) 159 (17.6%) yr 100 (11.1%) 90 (10.0%) yr 124 (13.7%) 115 (12.7%) yr 118 (13.1%) 136 (15.0%) yr 167 (18.5%) 187 (20.7%) yr 236 (26.1%) 217 (24.0%) Sex Female 636 (70.4%) 648 (71.7%) Race White 845 (93.5%) 829 (91.7%) Black 34 (3.8%) 36 (4.0%) Other 25 (2.8%) 39 (4.3%) Socioeconomic level Low 67 (7.4%) 76 (8.4%) Medium 313 (34.6%) 309 (34.2%) High 471 (52.1%) 463 (51.2%) Missing 53 (5.9%) 56 (6.2%) Charlson Comorbidity Index score 1.4 ± ± Individual comorbidities Cerebrovascular disease 15 (1.7%) 17 (1.9%) Depression/bipolar disorders 186 (20.6%) 184 (20.4%) Diabetes mellitus 236 (26.1%) 255 (28.2%) Kidney diseases 106 (11.7%) 102 (11.3%) Rheumatoid arthritis 23 (2.5%) 25 (2.8%) Dementia 102 (11.3%) 103 (11.4%) Cancer 65 (7.2%) 73 (8.1%) Paget disease 0 (0.0%) 0 (0.0%) 0.0 Fracture with trauma codes ± 7 days of fracture 30 (3.3%) 31 (3.4%) date Site of first fracture Vertebral 223 (24.7%) 243 (26.9%) Any nonvertebral 724 (80.1%) 693 (76.7%) Hip, pelvis, femur 334 (37.0%) 352 (38.9%) Other nonvertebral # 423 (46.8%) 368 (40.7%) 0.009** 12.3 Physician specialty for first fracture Emergency medicine 279 (30.9%) 271 (30.0%) Internal/family medicine/general practice 227 (25.1%) 241 (26.7%) Nurse practitioner 6 (0.7%) 7 (0.8%) Orthopaedics 391 (43.3%) 371 (41.0%) Radiology 21 (2.3%) 26 (2.9%) Rehabilitation pain 22 (2.4%) 20 (2.2%) Endocrinology 0 (0.0%) 0 (0.0%) 0.0 Rheumatology 0 (0.0%) 0 (0.0%) 0.0 Other 204 (22.6%) 217 (24.0%) Missing 0 (0.0%) 0 (0.0%) 0.0 Time from fracture date to index date (days) 24 ± ±
5 Page 5 Osteoporosis-related measures Filled osteoporosis medication prescriptions 65 (7.2%) 69 (7.6%) Anabolics 5 (0.6%) 2 (0.2%) Antiresorptives Oral bisphosphonates 43 (4.8%) 47 (5.2%) Injectable bisphosphonates 6 (0.7%) 6 (0.7%) Other injectable antiresorptives 2 (0.2%) 4 (0.4%) Other antiresorptives 11 (1.2%) 11 (1.2%) Filled concomitant medication prescriptions 256 (28.3%) 234 (25.9%) BMD assessments 66 (7.3%) 79 (8.7%) Filled Paget disease medications prescriptions## 0 (0.0%) 2 (0.2%) Index year (18.1%) 156 (17.3%) (30.6%) 282 (31.2%) (25.0%) 238 (26.3%) (26.2%) 228 (25.2%) (0.0%) 0 (0%) 0.0 *The values are given as the number of patients, with the percentage of the cohort in parentheses, with the exception of age, Charlson Comorbidity Index, and time from fracture date to index date, which are given as the mean and standard deviation. Testing the null hypothesis of no difference between the exposed and unexposed cohorts using t tests for means and chi-square tests for proportions. Vertebral fractures; any nonvertebral fractures; hip, pelvic, or femoral fractures; and other nonvertebral fractures were identified by ICD-9-CM and HCPCS codes listed in Table E-1. Any nonvertebral fractures included those occurring in the hip, pelvis, or femur, upper limb, lower limb, upper body, or unspecified nonvertebral sites as identified by ICD- 9-CM and HCPCS codes listed in Table E-1. #Other nonvertebral fractures included those occurring in the upper limb, lower limb, upper body, or unspecified nonvertebral sites as identified by ICD-9-CM and HCPCS codes listed in Table E-1. **Significant. Osteoporosis medications included anabolics (teriparatide); antiresorptives (oral bisphosphonates [alendronate {5 or 10 mg daily, 35 or 70 mg weekly}, alendronate sodium/cholecalciferol, risedronate {5 mg daily, 35 mg weekly, 75 or 150 mg monthly}, ibandronate {150 mg monthly}, risedronate sodium/calcium carbonate]; injectable bisphosphonates [zoledronic acid, ibandronate sodium/isopropyl alcohol, ibandronate sodium {3 ml}, ibandronate intravenous {IV}, pamidronate disodium]; other injectable antiresorptives [denosumab]; and other antiresorptives [calcitonin {200 IU/mL daily nasally}, raloxifene {60 mg daily}]). Concomitant medications included other antiresorptives, glucocorticoids, and anticonvulsants detailed in Table E-1. BMD assessments were identified by CPT codes 76499, 76977, 77078, 77080, 77081, 77083, 77085, 77086, 78350, and ##Paget disease treatments included risedronate (30 mg), alendronate (40 mg), etidronate (200 or 400 mg), pamidronate disodium (30 mg), and tiludronate (400 mg).
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