Replication of the HORIZON Pivotal Fracture Trial in Healthcare Claims Data
Conditions: Osteoporosis
Sponsor: Brigham and Women's Hospital

 
 
 
 
 
Once-Yearly Zoledronic Acid for Treatment of Postmenopausal Osteoporosis 
(HORIZON - Pivotal Fracture Trial, PFT) 
 
 
DUPLICATE HORIZON-PFT 
 
 
February 11, 2021 
 
NCT00049829 
 
 

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1 
1. RCT Details 
 
This section provides a high-level overview of a published RCT that the described real-world evidence study is trying to replicate as closely 
as possible given the remaining limitations inherent in the healthcare databases. 
 
1.1 
Title 
Once-Yearly Zoledronic Acid for Treatment of Postmenopausal Osteoporosis (HORIZON - Pivotal Fracture Trial, PFT) 
 
1.2 
Intended aim(s) 
To assess the effects of 15-minutes annual infusions of zoledronic acid (5mg) on hip fracture risk in postmenopausal women with 
osteoporosis during a 3-year period.  
 
1.3 
Primary endpoint for replication  
Co-primary endpoints were incidence of hip fracture and incidence of vertebral fracture. We focus on the risk of hip fracture for 
replication. 
 
1.4 
Required power for primary endpoint and noninferiority margin (if applicable) 
Assuming a 3-year fracture rate of 1.8% in the placebo group, it was determined that with 7,400 patients the log-rank test had a power of 
90% (with a two-sided alpha of 0.05) to detect a 50% reduction in hip fractures. 
 
1.5 
Secondary endpoint for replication (assay sensitivity) and RCT finding 
Non-vertebral fracture 
 
1.6 
Trial estimate 
Hazard Ratio, HR = 0.59 (95% CI, 0.42 to 0.83) comparing zoledronic-acid group vs. placebo group during a 3-year 
period (Black et al., 2007).  
 
Note. The follow-up period of the RWE replication is set at 18months. In the trial, the HR comparing zoledronic-acid group vs. 
placebo group during an 18-month period is estimated to be ~ 0.745. The HR at 18 months is defined as the ratio between the 
cumulative incidences of hip fracture events in the zoledronic-acid and placebo groups (!" = 
!"!"
!"#$%&'()) measured after 18 
months of follow-up. The estimates of the cumulative incidences of hip fracture events have been extracted by the Kaplan-Meier 
curves reported in the trial using a dedicated software (Graph Grabber 2.0.2, Quintessa Ldt). 
 
 
 
 

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2 
 
2. Person responsible for implementation of replication in Aetion 
 
Elvira D’Andrea, MD, MPH, implemented the study design in the Aetion Evidence Platform. She is not responsible for the validity of the design 
and analytic choices. All implementation steps are recorded, and the implementation history is archived in the platform. 
 
3. Data Source(s) 
 
Optum CDM, IBM® MarketScan® 
 
4. Study Design Diagram 
 
The study design diagram visualizes key aspects of the longitudinal study design for expedited review. 
 
 
 

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Figure 1. Design Diagram – HORIZON-PFT TRIAL REPLICATION 
 

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5. Cohort Identification  
 
5.1 Cohort Summary 
This study will involve a new user, parallel group, propensity score-matched, retrospective cohort study design comparing 15-minute annual 
infusions of zoledronic acid (5mg) to raloxifene (as a proxy for placebo). Raloxifene was selected as the placebo proxy because raloxifene was 
the most common concomitant osteoporosis medication used in the trial in both study arms. In addition, prior evidence indicates no effect of 
raloxifene on the primary outcome of hip fracture (Ettinger et al., 1999, Ensrued et al., 2008). The patients will be required to have continuous 
enrollment during a baseline period of 450 days (15 months) before initiation of zoledronic acid or comparator. We will restrict the analyses to 
women, older than 65, with osteoporosis. 
 
5.2 Important steps for cohort formation 
New use of zoledronic acid (exposure) is defined as no use of the exposure drug in the 450 days prior to index date. New users of zoledronic 
acid will be allowed to receive concomitant therapy with raloxifene before and/or during the study period, similar to the trial. We use the long 
look-back period of 450 days to define new use because zoledronic acid is given as a yearly infusion; thus, a identifying whether a patient has 
current zoledronic acid exposure requires at least 365 days of look back. We extended this lookback to 450 days (approximately 15 months) to 
allow for patients who have a short gap between infusions. To keep the amount of lookback available in the 2 treatment groups equal, New use 
of raloxifene (comparator, proxy to placebo) was also defined as no use of either exposure or comparator drugs in the 450 days prior to index 
date. 
 
5.2.1 
Eligible cohort entry dates 
Zoledronic acid indication for treatment of postmenopausal women with osteoporosis was approved by FDA on Aug 20, 2007.  
§ 
IBM® MarketScan®: Aug 21, 2007 – December 31, 2018 (end of available data)  
§ 
Optum CDM: Aug 21, 2007 – Mar 31, 2020 (end of available data)  
 
5.2.2 
Specify inclusion/exclusion criteria for cohort entry and define the index date 
Inclusion and exclusion criteria were adapted from the trial as closely as possible. Definitions for all inclusion/exclusion are provided in 
Appendix A and are summarized in the flowcharts below.  
 
5.3 Flowchart of the study cohort assembly 
For zoledronic acid vs. raloxifene 
 
  
Optum CDM 
IBM® MarketScan® 
  
Excluded 
Patients 
Remaining 
Patients 
Excluded 
Patients 
Remaining 
Patients 
All patients 
 
77,673,639 
 
200,203,908 

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Did not meet cohort entry criteria 
-77,476,067 
197,572 
-
199,714,801 
489,107 
Excluded due to insufficient enrollment 
-52,317 
145,255 
-164,242 
324,865 
Excluded due to prior use of referent 
-81,791 
63,464 
-185,458 
139,407 
Excluded due to prior use of exposure 
-9,268 
54,196 
-29,153 
110,254 
Excluded because patient qualified in >1 exposure category 
-1 
54,195 
-1 
110,253 
Excluded based on Inclusion #1 - Age, range 65-89 years 
-17,914 
36,281 
-58,739 
51,514 
Excluded based on Inclusion #2 - Gender, female [Excluded if Male or Unknown] 
-6,080 
30,201 
-6,857 
44,657 
Excluded based on Inclusion #3 - Osteoporosis 
-3,624 
26,577 
-3,936 
40,721 
Excluded based on Exclusion #1 - Oral bisphosphonate use 
-6,854 
19,723 
-10,259 
30,462 
Excluded based on Exclusion #2.1 - PTH or PTH analogue use 
-305 
19,418 
-814 
29,648 
Excluded based on Exclusion #2.2 - Anabolic–androgenic steroids (AAS) and 
growth hormones (GH) 
-10 
19,408 
-32 
29,616 
Excluded based on Exclusion #2.3 - Glucocorticoids use 
-1,352 
18,056 
-1,697 
27,919 
Excluded based on Exclusion #3 - CCI (180 days) >=10 
-196 
17,860 
-154 
27,765 
Excluded based on Exclusion #4 - Malignant neoplasm, excluding non-melanoma 
skin cancer 
-2,461 
15,399 
-4,141 
23,624 
Excluded based on Exclusion #5 - Disorders that influence bone metabolism 
-1,426 
13,973 
-2,235 
21,389 
Excluded based on Exclusion #6 - Glucocorticoid-Induced Osteoporosis 
-4 
13,969 
-5 
21,384 
Excluded based on Exclusion #7 - Paget’s Disease 
-43 
13,926 
-65 
21,319 
Excluded based on Exclusion #8 - Alcohol abuse or Drug addiction or Non-
compliance 
-141 
13,785 
-137 
21,182 
Excluded based on Exclusion #9 - Pregnancy 
-1 
13,784 
-3 
21,179 
Excluded based on Exclusion #10 - Lower extremity amputation 
-18 
13,766 
-37 
21,142 
Excluded based on Exclusion #11 - Denosumab use  
-53 
13,713 
-35 
21,107 
Excluded based on Exclusion #12 - Zoledronic Acid use (for raloxifene users) 
-223 
13,490 
-313 
20,794 
Excluded based on Exclusion criteria #13 - End-stage renal disease 
-5 
13,485 
-12 
20,782 
Excluded based on Exclusion criteria #14 - End-stage liver disease 
-33 
13,452 
-66 
20,716 
Excluded based on Exclusion criteria #15 - Blindness or low vision 
-32 
13,420 
-25 
20,691 
Excluded based on Exclusion criteria #16 - Abaloparatide 
-0 
13,420 
-0 
20,691 
Excluded based on Exclusion criteria #17 - Romosozumab 
-0 
13,420 
-0 
20,691 
Final cohort 
-- 
13,420 
-- 
20,691 

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6. Variables  
 
6.1 Exposure-related variables:  
 
Study drug:  
The study exposure of interest is new initiation of zoledronic acid 5 mg, IV administered annually. New initiation will be defined by no use of 
zoledronic acid in the prior 15 months (450 days) before treatment initiation (washout period). 
 
Comparator agents: 
 
Primary analysis: 
- 
New initiators of raloxifene, oral tablet administered daily. New initiation will be defined by no use of raloxifene and zoledronic acid in 
the prior 15 months (450 days) before treatment initiation (washout period). 
 
Secondary analysis: 
- 
Non-user comparator (risk-set sampled cohort). 
 
6.2 Preliminary Covariates: 
 
• 
Age 
• 
Combined Comorbidity Index (CCI), measured over the baseline covariate assessment period, defined as 180 days prior to and including 
index date. 
 
Covariates listed above represent only a small subset of covariates that will ultimately be controlled for in the design and analysis. We use the 
covariates above only for initial feasibility analyses to judge whether there is likely to be sufficient overlap between treatment groups to 
proceed with the study. Remaining covariates are defined only after the study has passed the initial feasibility analysis and the initial power 
assessment and are listed in Table 1 (Appendix B). Gender is not included since the study is already restricted to female subjects. 
 
 
6.3 Outcome variables and study follow-up:  
 
6.3.1 
Outcome variables 
 
Effectiveness outcome variables of interest (definitions provided in Appendix A): 
§ 
Primary outcome: Hip fracture  

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§ 
Secondary outcome:  
o Non-vertebral fracture 
 
6.3.2 
Study follow-up 
Intention-to-treat (ITT) analysis will be conducted with treatment defined as the index drug on day of cohort entry. Because the exposure 
(zoledronic acid) is administered annually, patients receiving the exposure are automatically covered with medication for at least 12 months. In 
addition, the comparator (raloxifene) is intended to proxy for placebo, so nonadherence to the comparator does not result in meaningful exposure 
misclassification. Therefore, the ITT analysis with a follow-up of 18 months (540 days) will be the primary analysis.  
The follow-up will start the day after drug initiation (i.e., cohort entry date), as described in the HORIZON-PFT, and will continue until the 
earliest date of the following events: 
• 
The first occurrence of the outcome of interest, 
• 
The date of end of continuous registration in the database, 
• 
End of the study period, 
• 
Measured death event occurs, 
• 
Nursing home admission 
o Nursing home admissions are considered a censoring event because the data sources utilized typically provide little to no data on a 
patient, particularly on drug utilization, after admission. We will utilize this as an exclusion reason for cohorts for the same 
reason.   
 
7. Initial Feasibility Analysis  
 
Aetion report name: 
 
For zoledronic acid vs. raloxifene  
Optum CDM- https://bwh-dope.aetion.com/projects/details/1406/results/60058/result/0 
IBM® MarketScan®- https://bwh-dope.aetion.com/projects/details/1407/results/60060/result/0 
 
Date conducted: 10/17/2020 
 
Complete Aetion feasibility analysis using age and CCI as the only covariates and the primary endpoint (Section 6.3.1) as the outcome. No 
measures of association will be computed nor will incidence rates stratified by treatment group. 
 
• 
Report patient characteristics by treatment group 

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§ 
For zoledronic acid vs. raloxifene 
 
  
Optum CDM 
IBM® MarketScan® 
Variable 
Raloxifene - 
Comparator 
Zoledronic Acid - 
Exposure 
Difference 
Raloxifene - 
Reference 
Zoledronic acid - 
Exposure 
Difference 
Number of patients 
6,815 
6,605 
- 
6,694 
13,997 
- 
Age 
  
  
  
  
  
  
...mean (sd) 
73.41 (5.90) 
74.02 (5.52) 
-0.62 (-0.81, -
0.42) 
73.81 (7.06) 
75.61 (7.14) 
-1.80 (-2.01, -
1.60) 
...median [IQR] 
73.00 [68.00, 
78.00] 
75.00 [69.00, 
79.00] 
- 
72.00 [68.00, 
79.00] 
75.00 [70.00, 
81.00] 
- 
Combined 
Comorbidity Score - 
CCI (180 days) 
  
  
  
  
  
  
...mean (sd) 
1.38 (1.52) 
1.49 (1.56) 
-0.11 (-0.16, -
0.06) 
0.96 (1.20) 
1.22 (1.35) 
-0.27 (-0.30, -
0.23) 
...median [IQR] 
1.00 [0.00, 2.00] 
1.00 [0.00, 2.00] 
- 
1.00 [0.00, 1.00] 
1.00 [0.00, 2.00] 
- 
 
• 
Report summary parameters of study population FEASIBILITY- FOR STUDY OUTCOME 
§ 
For zoledronic acid vs. raloxifene 
 

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9 
 
Optum CDM 
IBM® 
MarketScan® 
Number of patients in full cohort 
13,420 
20,691 
Number of patients dropped as incomplete cases 
0 
0 
Number of patients that did not begin follow-up 
0 
0 
Number of patients in analytic cohort 
13,420 
20,691 
Number of events 
146 
208 
Number of person-years 
16,243 
24,519 
Number of patients in group: Raloxifene - Comparator 
6,815 
6,694 
Number of patients in group: Zoledronic Acid - Exposure 
6,605 
13,997 
Risk per 1,000 patients 
10.88 
10.05 
Rate per 1,000 person-years 
- 
- 
 
• 
Report median follow-up time by treatment group 
§ 
For zoledronic acid vs. raloxifene 
 
Median Follow-Up Time (Days) [IQR] – ITT analysis 
Patient Group 
Optum CDM 
IBM® 
MarketScan® 
Overall Patient Population 
540 [375, 540] 
540 [340, 540] 
Referent - Raloxifene 
540 [363, 540] 
540 [363, 540] 
Exposure - ZA 
540 [383, 540] 
540 [329, 540] 
 
• 
Report reasons for censoring in the overall study population 
§ 
For zoledronic acid vs. raloxifene 
 

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Reasons  
Optum CDM 
IBM® 
MarketScan® 
Overall 
10750 
17260 
Outcome 
146 (1.1%) 
208 (1.0%) 
Death 
0 (0.0%) 
62 (0.3%) 
Maximum follow-up time 
8,891 (66.3%) 
13,112 (63.4%) 
End of patient data 
0 (0.0%) 
0 (0.0%) 
End of patient enrollment 
2,589 (19.3%) 
5,969 (28.8%) 
Nursing home Occurred 
838 (6.2%) 
630 (3.0%) 
 
• 
Report overall risk of the primary outcome. 
 
  
Optum CDM 
IBM® 
MarketScan® 
Pooled 
Risk per 1,000 patients 
10.9 
10.1 
10.4 
 
 
8. Initial Power Assessment 
 
Aetion report name: 
 
For zoledronic acid vs. raloxifene 
Optum CDM- https://bwh-dope.aetion.com/projects/details/1406/results/60059/result/0 
IBM® MarketScan®- https://bwh-dope.aetion.com/projects/details/1407/results/60061/result/0 
 
Date conducted:  10/17/2020 
 
In order to complete the initial power analysis, the dummy outcome of a 90-day gap in database enrollment will be used. This outcome is used to 
ensure that no information on the comparative risks of the outcomes of interest are available at this stage. Complete a 1:1 PS-matched comparative 
analysis using this outcome. PS should include only 2 covariates: age and combined comorbidity index. Power calculations are based on the 
formulas from Chow et al. (2008). 
 

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• 
Stop analyses until feasibility and power are reviewed by primary investigators and FDA. Reviewers evaluate the results of the analyses 
described above in Sections 7 and 8, including numbers of patients, patient characteristics, follow-up time, and reasons for censoring by 
treatment group, as well as overall rates of outcomes and study power. These parameters are re-evaluated and reported in the subsequent 
sections, after incorporating feedback and refining the protocol. 
 
o Pooled 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Superiority Analysis
Number of patients matched
25,518
Reference
12,759
Exposed
12,759
Risk per 1,000 patients
10.40
Desired HR from RCT
0.59
Alpha (2-sided)
0.05
Number of events expected
265.3872
Power
0.990300973

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o Optum CDM 
 
 
o IBM® MarketScan® 
 
Superiority Analysis
Number of patients matched
12,130
Reference
6,065
Exposed
6,065
Risk per 1,000 patients
10.90
Desired HR from RCT
0.59
Alpha (2-sided)
0.05
Number of events expected
132.217
Power
0.858487133
Superiority Analysis
Number of patients matched
13,388
Reference
6,694
Exposed
6,694
Risk per 1,000 patients
10.10
Desired HR from RCT
0.59
Alpha (2-sided)
0.05
Number of events expected
135.2188
Power
0.86602361

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13 
 
• 
Stop analyses until feasibility and power are reviewed by primary investigators, FDA, and assigned members of advisory board. 
Reviewed by PI: 
Jessica Franklin 
Date reviewed: 
10/29/20 
Reviewed by FDA: 
Ken Quinto 
Date reviewed: 
11/15/20 
Reasons for stopping 
analysis (if required): 
 
 
 
9. Balance Assessment 
 
Aetion report name: 
 
For zoledronic acid vs. raloxifene 
Optum CDM: https://bwh-dope.aetion.com/projects/details/1406/results/64560/result/0 
IBM® MarketScan®: https://bwh-dope.aetion.com/projects/details/1407/results/64559/result/0 
 
Date conducted: 01/19/2021 
 
After review of initial feasibility and power analyses, complete creation of the remaining covariates from Section 6.2. Again, using the dummy 
outcome of a 90-day gap in database enrollment, complete a 1:1 PS-matched analysis. The PS should include the complete list of covariates. 
 
• 
Provide plot of PS distributions stratified by treatment group. 
 
Note- Please refer to Appendix B.  
 
 
• 
Report covariate balance after matching. 
 
Note- For Table 1, please refer to Appendix B.  
 
 
 
 
 
 
 

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14 
 
 
• 
Report reasons for censoring by treatment group. 
 
Overall 
Referent 
Exposure 
Dummy outcome 
697 (3.87%) 
350 (3.88%) 
347 (3.85%) 
Death 
89 (0.49%) 
36 (0.40%) 
53 (0.59%) 
End of index exposure 
762 (4.23%) 
372 (4.13%) 
390 (4.33%) 
Maximum follow-up time 
11993 (66.52%) 
6058 (67.21%) 
5935 (65.84%)  
End of patient enrollment 
4487 (24.89%) 
2198 (24.38%) 
2289 (25.39%) 
 
• 
Report follow-up time by treatment group. 
Median Follow-Up Time (Days) [IQR] – ITT analysis 
Patient Group 
Optum CDM 
IBM® MarketScan® 
Overall Patient Population 
540 [404.5, 540] 
540 [365, 540] 
Referent - Raloxifene 
540 [426, 540] 
540 [365, 540] 
Exposure - ZA 
540 [386, 540] 
540 [364.5, 540] 
 
• 
Report overall risk of the primary outcome. 
  
Optum CDM 
IBM® MarketScan® 
Pooled 
Risk per 1,000 patients 
10.9 
10.1 
10.4 
 
10. Final Power Assessment 
 
Date conducted: 01/19/2021 
 
• 
Re-calculate power in the appropriate excel table, using the revised number of matched patients from the PS-match in Section 9. All other 
parameters in the table should be the same as in Section 8. 
 
 
 
 
 

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o Pooled 
 
 
o Optum CDM 
  
Superiority Analysis
Number of patients matched
18,028
Reference
9,014
Exposed
9,014
Risk per 1,000 patients
10.40
Desired HR from RCT
0.59
Alpha (2-sided)
0.05
Number of events expected
187.4912
Power
0.950774073
Superiority Analysis
Number of patients matched
6,396
Reference
3,198
Exposed
3,198
Risk per 1,000 patients
10.90
Desired HR from RCT
0.59
Alpha (2-sided)
0.05
Number of events expected
69.7164
Power
0.595938014

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o IBM® MarketScan® 
 
 
 
 
• 
Stop analyses until balance and final power assessment are reviewed by primary investigators, FDA, and assigned members of advisory board. 
Reviewed by PI: 
Jessica Franklin 
Date reviewed: 
01/19/21 
Reviewed by FDA: 
Ken Quinto 
Date reviewed: 
01/19/21 
Reasons for stopping 
analysis (if required): 
 
 
 
11. Study Confidence and Concerns 
 
Deadline for voting on study confidence and listing concerns: 
Date votes and concerns are summarized:    
 
• 
If final feasibility and power analyses are reviewed and approved, proceed to the remaining protocol steps. 
• 
All study team and advisory board members that review this protocol should at this stage provide their level of confidence for the success of 
the RWD study in the Google Form. This form also provides space for reviewers to list any concerns that they feel may contribute to a failure 
to replicate the findings of the RCT, including differences in study populations, poor measurement of study variables, or residual confounding. 
Superiority Analysis
Number of patients matched
11,632
Reference
5,816
Exposed
5,816
Risk per 1,000 patients
10.10
Desired HR from RCT
0.59
Alpha (2-sided)
0.05
Number of events expected
117.4832
Power
0.815816276

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All responses will be kept confidential and individual-level results will only be shared with the individual respondent. 
• 
After the deadline for voting has passed, provide the distribution of responses and summarize all concerns here. 
 
12. Register study protocol on clinicalTrials.gov 
 
Date conducted:    
 
• 
Register the study on clinicalTrials.gov and upload this document. 
 
13. Comparative Analyses 
 
Aetion report name: 
Date conducted:    
 
13.1 For primary analysis:  
 
In the PS-matched cohort from Section 9, to estimate the risk of hip fracture for zoledronic acid users versus raloxifene users during an 18-
month period using a Cox regression hazard regression model.  
 
13.2 For sensitivity analyses:  
 
Secondary analyses:  
§ 
In the PS-matched cohort from Section 9, to estimate the risk of non-vertebral fracture for zoledronic acid users versus 
raloxifene users during an 18-month period using a Cox regression hazard regression model. 
§ 
To estimate the risk of hip fracture for zoledronic acid versus non-user comparator using a risk-set sampled cohort. 
 
 
Subgroup analysis: In the PS-matched cohort from Section 9, to estimate the risk of hip fracture stratified by age (women younger 
or older than 75 years). The estimates are compared with the results from a post-hoc analysis of the Horizon-PFT on women older 
than or equal to 75 (Boonen et al.).  
 
 
 
 
 
 

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14.  Requested Results  
 
14.1 Table 1: Baseline characteristics before and after adjustment 
 
Variable 
 
Before adjustment 
After adjustment 
Referent 
Exposure 
Std. diff. 
Referent 
Exposure 
Std. diff. 
Number of 
patients 
 
 
- 
 
 
- 
Age categories 
 
 
 
 
 
 
… 
 
 
 
 
 
 
 
 
14.2 Table 2: Follow-up time 
 
Patient Group 
Median Follow-Up Time (Days) [IQR] 
Overall Patient Population 
 
Referent 
 
Exposure 
 
 
14.3 Table 3: Censoring events 
 
 
Overall 
Referent 
Exposure 
Outcome 
 
 
 
Death 
 
 
 
Start of an additional exposure 
 
 
 
End of index exposure 
 
 
 
Specified date reached 
 
 
 
End of patient data 
 
 
 
End of patient enrollment 
 
 
 
… 
 
 
 
 
 

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14.4 Table 4: Results from primary analysis 
 
Analysis 
No. exposed 
events 
No. referent 
events 
Exposed rate 
Referent rate 
HR (95% CI) 
Crude 
 
 
 
 
 
Analysis 1 
 
 
 
 
 
... 
 
 
 
 
 
HR, Hazard Ratio; CI, Confidence Interval. 
 
14.5 Table 5: Results from secondary analyses 
 
 
15. References 
 
Black DM, Delmas PD, Eastell R, Reid IR, Boonen S, Cauley JA, Cosman F, Lakatos P, Leung PC, Man Z, Mautalen C, Mesenbrink P, Hu H, 
Caminis J, Tong K, Rosario-Jansen T, Krasnow J, Hue TF, Sellmeyer D, Eriksen EF, Cummings SR; HORIZON Pivotal Fracture Trial. Once-yearly 
zoledronic acid for treatment of postmenopausal osteoporosis. N Engl J Med. 2007 May 3;356(18):1809-22. doi: 10.1056/NEJMoa067312. 
 
Chow S, Shao J, Wang H. 2008.  Sample Size Calculations in Clinical Research. 2nd Ed. Chapman & Hall/CRC Biostatistics Series. page 177 
Ensrud KE, Stock JL, Barrett‐Connor E, Grady D, Mosca L, Khaw KT, Zhao Q, Agnusdei D, Cauley JA. Effects of raloxifene on fracture risk in 
postmenopausal women: the Raloxifene Use for the Heart Trial. Journal of bone and mineral research. 2008 Jan;23(1):112-20. 
Ettinger B, Black DM, Mitlak BH, Knickerbocker RK, Nickelsen T, Genant HK, Christiansen C, Delmas PD, Zanchetta JR, Stakkestad J, Glüer 
CC. Reduction of vertebral fracture risk in postmenopausal women with osteoporosis treated with raloxifene: results from a 3-year randomized 
clinical trial. Jama. 1999 Aug 18;282(7):637-45. 
Wright NC, Daigle SG, Melton ME, Delzell ES, Balasubramanian A, Curtis JR. The Design and Validation of a New Algorithm to Identify 
Incident Fractures in Administrative Claims Data. J Bone Miner Res. 2019 Oct;34(10):1798-1807. doi: 10.1002/jbmr.3807. 
Boonen S, Black DM, Colón-Emeric CS, et al. Efficacy and safety of a once-yearly intravenous zoledronic acid 5 mg for fracture prevention in 
elderly postmenopausal women with osteoporosis aged 75 and older. J Am Geriatr Soc. 2010;58(2):292-299. doi:10.1111/j.1532-
5415.2009.02673.x 

#
HORIZON-PFT trial definitions
Implementation in routine care
References/Rationale
Color coding
Exposure: Zoledronic acid (5 mg) 15-minute intravenous administration every year for 3 years vs. placebo
Reference: Placebo
Aim: To evaluate the effect of annual infusions of zoledronic acid on fracture risk during a 3-year
period in postmenopausal women with osteoporosis
All patients received oral daily calcium (1000 to 1500 mg) and vitamin D (400 to 1200 IU). 
Exposure: new-use of Zoledronic acid (washout 450 days)
NDC Generic Name:
ZOLEDRONIC ACID
ZOLEDRONIC ACID IN MANNITOL & WATER FOR INJECTION
ZOLEDRONIC ACID IN MANNITOL AND 0.9 % SODIUM CHLORIDE
ZOLEDRONIC ACID IN MANNITOL AND WATER FOR INJECTION
NDC codes: 143964201, 16729024231, 17478032705, 25021080167, 42023015101, 43598033011, 47335003540, 
47335096241, 54288010001, 5511106850755150026605, 67457039054, 68001036625, 78035084, 78038725, 
409421501, 409421505, 16714081501, 17478032745, 23155017031, 25021080166, 45963044055, 51991006598, 
53150087101, 60505611000, 63323096198, 68001036622, 78043561, 78059061, 409422801, 409422901, 
23155018631, 25021082666, 25021082667, 25021082682, 25021083082, 35356035101, 42023016301, 
43598033111, 51991006498, 55111068852, 63323096600, 67457061910, 67457079410, 70860021051
CPT/HCPCS Procedure Codes:
C9115, J3487, J3488, J3489, Q2051, Q4095
Reference of primary analysis: Raloxifene (proxy of placebo) 
Reference of secondary analysis: non-users (proxy of placebo)
Criteria
Adequate mapping in claims
Hip fracture
(Dual-energy x-ray absorptiometry of the hip was performed at baseline and at months 6, 12, 24, and 36 for bone 
loss)  - both patients in stratum 1 and stratum 2
Measured 1 day after drug initiation (codes reported in "Hip and femur fractures codes": 
Hip and femur fracture:
Algorithm include the following case-qualifyng (CQ):
       CQ = 1 Inpatient claim with primary diagnosis code
AND
       CQ = 2 Inpatient claim with secondary diagnosis code
AND
       CQ = 3 Non‐inpatient claim with diagnosis code AND HCPCS in (27125, 27130, 27220, 27222, 27226‐27228, 
27230‐27248, 27254, 27267‐27269, 27500‐27514) 
OR Non‐inpatient claim with diagnosis code AND ICD‐9 Procedure Code in (7855, 7905, 7915, 7925, 7935, 
7965, 8151, 8152)
Wright NC, Daigle SG, Melton ME, Delzell ES, 
Balasubramanian A, Curtis JR. The Design and 
Validation of a New Algorithm to Identify Incident 
Fractures in Administrative Claims Data. J Bone 
Miner Res. 2019 Oct;34(10):1798-1807. doi: 
10.1002/jbmr.3807. Epub 2019 Aug 5. PMID: 
31170317.
Intermediate mapping in claims
New Vertebral Fractures [only in patients who were not taking any osteoporosis medications at the time of 
randomization] only patients in stratum 1
(Spinal lateral radiographs were obtained at baseline and at 12, 24, and 36 months or early termination
for patients in stratum 1 and at baseline and at 36 months or early termination for patients in stratum 2)
Measured 1 day after drug initiation:
Vertebral Fractures:
Algorithm include the following case-qualifyng (CQ):
CQ = 1 Inpatient claim with primary diagnosis code
AND
CQ = 2 Non‐inpatient claim with diagnosis code AND HCPCS in (22305, 22310, 22315, 22318, 22319, 22325‐22328, 
22510‐22515, 22520‐22525, 27200, 27202, 72291, 72292, 76012, 76013, 77082, 77085, 77086, S2360‐S2363)
AND
CQ = 3 Non‐inpatient claim with diagnosis code AND HCPCS in (99024, 99058,99201‐99215, 99241‐99245, 
99271‐99285, 99301–99355, 99366, 99385–99387,99395–99404, 99429, 99499) [Physician E&M codes] plus, up to 
10 days earlier
(or on the same day), Outpatient claim with HCPCS in (72010‐72159, 72240‐72285, 72295) [Spine imaging codes]
Outcome not included in the final analysis
Wright NC, Daigle SG, Melton ME, Delzell ES, 
Balasubramanian A, Curtis JR. The Design and 
Validation of a New Algorithm to Identify Incident 
Fractures in Administrative Claims Data. J Bone 
Miner Res. 2019 Oct;34(10):1798-1807. doi: 
10.1002/jbmr.3807. Epub 2019 Aug 5. PMID: 
31170317.
Poor mapping or cannot be measured in claims 
Can't be measured in claims but not important for the analysis
1
Postmenopausal women between the ages of 65 and 89 years
Female, 65-89 years at the time of drug initiation
2
Bone mineral density T score of −2.5 or less at the femoral neck, with or without evidence of existing
vertebral fracture, or a T score of −1.5 or less, with radiologic evidence of at least two mild vertebral
fractures or one moderate vertebral fracture.
Measured time of enrollment to prior to the day of drug initiation inpatient (any position), outpatient (any position):
Osteoporosis diagnosis
ICD-9 diagnosis: 733.00, 733.01, 733.02, 733.03, 733.09, 733.13
ICD-10 diagnosis: M81.0, M81.6, M81.8, M80.88*, M80.08*
OR
Measured time of enrollment to 730 days (2 years) prior to the day of drug initiation:
Alendronate, Ibandronate, Risedronate, Pamidronate, Etidronate, Tiludronate
Please see the following Google Drive for further details or any missing information: 
https://drive.google.com/drive/folders/1WD618wrywYjEaXzfLTcuK-VCcnb6b-gV?usp=sharing
ICD-10 codes are not listed in this document because of excel cell size limitations and excessive number of ICD-10 codes. Full ICD-
10 code lists will be available in the above Google Drive Folder (link above). ICD-9 to ICD-10 code conversions were completed 
using a SAS macro that implements forward/ backward mapping based on the CMS ICD-9 to ICD-10 mapping:
 https://www.nber.org/data/icd9-icd-10-cm-and-pcs-crosswalk-general-equivalence-mapping.html
Adequate mapping in claims of criteria extracted from clinicaltrial.gov 
(ESLD and Svere eye disease), after clinical review with FDA 
(Abaloparatide, Romosozumab) or from the protocol of Horizon-recurrent 
(all other criteria in blue): "Colón-Emeric CS, Caminis J, Suh TT, Pieper 
CF, Janning C, Magaziner J, Adachi J, Rosario-Jansen T, Mesenbrink P, 
Horowitz ZD, Lyles KW; HORIZON Recurrent Fracture Trial. The 
HORIZON Recurrent Fracture Trial: design of a clinical trial in the 
prevention of subsequent fractures after low trauma hip fracture repair. 
Curr Med Res Opin. 2004 Jun;20(6):903-10. doi: 
10.1185/030079904125003683. PMID: 15200749."
Protocol of Horizon-pivotal not available - numerous unsuccessful attempts 
had been made to retrive it from the authors
Trial details - clinicaltrial.gov NCT00049829
EXPOSURE vs. COMPARISON
PRIMARY OUTCOME
INCLUSION CRITERIA
"QQFOEJY"

1
Bisphosphonate users such as Aredia® (pamidronate), Didronel® (etidronate), Fosamax® (alendronate), Actonel® 
(risedronate), Skelid® (tiludronate)
Measured 730 days (2 years) prior to the day of drug initiation:
Generic names:
Alendronate, Ibandronate, Risedronate, Pamidronate, Etidronate, Tiludronate
2.1
Previous use of: 
(1) any previous use of parathyroid hormone
Measured 730 days (2 years) prior to the day of drug initiation:
Generic names:
parathyroid hormone , teriparatide, abaloparatide
Brand names:
Natpara® (parathyroid hormone), Forteo®, Bonsity (teriparatide), Tymlos® (abaloparatide)
2.2
(2) use of anabolic steroids or growth hormone within 6 months before trial entry
Measured 180 days prior to the day of drug initiation:
AASs: 
Generic names: TESTOSTERONE, DIHYDROTESTOSTERONE PROPIONATE, ESTROGENS, 
ESTERIFIED/METHYLTESTOSTERONE, TESTOSTERONE CYPIONATE, MICRONIZED, TESTOSTERONE 
CYPIONATE/ESTRADIOL CYPIONATE, TESTOSTERONE ENANTHATE/ESTRADIOL VALERATE, TESTOSTERONE 
MICRONIZED, TESTOSTERONE UNDECANOATE, METHYLTESTOSTERONE, MICRONIZED, STANOLONE, 
OXYMETHOLONE, NANDROLONE PHENPROPIONATE, OXANDROLONE, STANOZOLOL, FLUOXYMESTERONE, 
TESTOSTERONE ENANTHATE, TESTOSTERONE PROPIONATE, NANDROLONE DECANOATE, METHYLTESTOSTERONE, 
TESTOSTERONE CYPIONATE
GHs:
Generic names: SOMATROPIN, TESAMORELIN ACETATE
Brand names: OMNITROPE, SAIZEN, ZOMACTON, GEREF, HUMATROPE, NUTROPIN, SEROSTIM, ZORBTIVE, EGRIFTA, 
MACRILEN, NORDITROPIN FLEXPRO, GENOTROPIN, TEV-TROPIN
2.3
OR
(3) oral or intravenous systemic corticosteroids within 12 months,
Measured 30 days prior to the day of drug initiation:
Injectable (IV) or (IM): 
NDC Generic Name:
methylprednisolone, hydrocortisone, dexamethasone
CPT/HCPCS Procedure Code:
J1020, J1030, J1040, J1720, J2920, J2930
Oral:
NDC Generic Name: 
Cortisone, hydrocortisone, prednisone, prednisolone, methylprednisolone, dexamethasone 
CPT/HCPCS Procedure Code: 
J7506, J7509, J7510, J8540
2.4
OR
(4) any previous use of strontium, or sodium fluoride within 6 months before trial entry
CRITERIA NOT APPLIED
Strontium not approved in USA for treatment of 
osteoporosis.
Sodium Fluoride is not used to treat the osteoporosiss 
since 2001/2002 when a RCT and sub meta-analysis 
showed an increased of risk of fractures in the exp 
arm
NA
Patients with a serum calcium level of more than 2.75 mmol per liter or less than 2.00 mmol per liter
N/A
NA
Patients with a calculated creatinine clearance of less than 30.0 ml per minute at either of two baseline visits or urine 
dipstick results of more than 2+ for protein, without evidence of contamination or bacteriuria.
N/A
NA
Written informed consent
N/A
3
Serious disease that may limit life expectancy to less than 6 months
(including sever liver and renal diseases)
Measured 180 days prior to the day of drug initiation:
CCI >=10  (life expectancy less than the expected duration of the trial)
4
New diagnosis or active treatment for any nonskin malignancy ≤ 12 months prior to randomization and any 
metastatic cancer
Measured 365 days prior to the day of drug initiation inpatient (any position), outpatient (any position):
Malignant neoplasm:
ICD-9 diagnosis: 140.xx-208.xx (except 173.xx, non-melanoma skin cancer)
ICD-10 diagnosis: C00-C43, C45-C97, D45
EXCLUSION CRITERIA
Appendix A

5
Conditions that influence bone metabolism
Measured 365 days prior to the day of drug initiation:
Anorexia and Bulimia:
ICD-9 diagnosis: 307.1, 307.5x, 783.0, 783.2x,783.3,783.6,783.9
ICD-10 diagnosis: F50.xx, R63.x 
Cushing syndrome and disorders of adrenal glands:
ICD-9 diagnosis: 255.xx
ICD-10 diagnosis: E24.x
Hyperparathyroidism and hyperthyroidism:
ICD-9 diagnosis: 252.x
ICD-10 diagnosis: E21.x, E20.x
Inflammatory conditions:
Rheumatoid arthritis
ICD-9 diagnosis: 714.0-714.4
ICD-10 diagnosis: M05.00,M05.05x,M05.15x,M05.25x,M05.35x,M05.45x, M05.55x, M05.65x, 
M05.75x,M05.85x,M05.60,M08.00,M08.40
Lupus
ICD-9 diagnosis: 710.0
ICD-10 diagnosis: M32.10
Crohn’s disease and other IBD
ICD-9 diagnosis: 555.x, 556.x
ICD-10 diagnosis: K50.xx, K51.xx
6
Treatment and Prevention of Glucocorticoid-Induced Osteoporosis
NB. The recommended regimen is a 5 mg infusion once a year given intravenously over no less than 15 minutes.
Measured 730 days (2 years) prior to the day of drug initiation:
ICD-9 diagnosis: E858.0, 962.0 Poisoning by adrenal cortical steroids, 
ICD-10 diagnosis: T38.0xx Adverse effect of glucocorticoids and synthetic analogues
7
Treatment of Paget’s Disease of Bone
NB. The recommended dose is a 5 mg infusion. The infusion time must not be less than 15 minutes given over a 
constant infusion rate. 
Measured 730 days (2 years) prior to drug initiation:
ICD-9 diagnosis: 731.0 Osteitis deformans without mention of bone tumor (Paget's Disease)
ICD-10 diagnosis: M88.xxx Osteitis deformans [Paget's disease of bone]
8
Other conditions/circumstances likely to lead to poor treatment adherence
Measured 365 days  prior to drug initiation in any diagnosis position in inpatient or outpatient care setting:
Alcohol Abuse or Dependence
ICD-9 diagnosis: 291.xx, 303.xx, 305.0x, 571.0x, 571.1x, 571.2x, 571.3x, 357.5x, 425.5x, E860.0x (CMS has not 
released mapping for new ICD10 for this code), V11.3x
ICD-10 diagnosis: F10.x, K70.x, G62.1, I42.6, 099.31x
OR
Drug Abuse or Dependence 
ICD-9 diagnosis: 292.xx, 304.xx, 305.2x-305.9x, 648.3x
ICD-10 diagnosis: F11.x, F12.x, F13.x, F14.x, F15.x, F16.x, F17.2x, F18.x, F19.x, F55.2, G62.0, 099.32x
OR
Non-compliance: 
ICD-9 diagnosis: V45.12, V15.81 
ICD-10 diagnosis: Z91.19, Z91.15 
9
Pregnancy (even though it is very unlikely to found cases we add this criteria to make sure all women are 
postmenopausal)
Measured 180 days prior to and including day of drug initiation in any diagnosis position and inpatient or outpatient 
care setting
Pregnancy (see "Pregnancy codes")
10
Low fracture risk or unlikely to benefit:
• Amputee
Measured time of enrollment to prior to the day of drug initiation inpatient (any position), outpatient (any position):
ICD-9 Diagnosis: Acquired absence of lower limb: V49.7x, Traumatic amputation 895.x, 896.x, 897.x
ICD-9 Procedure: Amputation Of Lower Limb: 84.1xx, 84.25-84.28
ICD-10 Diagnosis:  Acquired absence of lower limb: Z89.4xx,  Z89.5xx,  Z89.6xx, Traumatic amputation: S78.xxx 
ICD-10 Procedure: Detachment of lower limb: 0Y6xxx  
11
Zoledronic acid use (to exclude ZA use in the raloxifene group)
Measured  450 (1 year + 90 days) prior to the day of drug initiation:
(same as exposure)
12
Denosumab use
Measured  450 (1 year + 90 days) prior to the day of drug initiation:
Generic name:
Denosumab
Appendix A

13 
End-Stage Renal Disease
Measured 180 days prior to and including day of drug initiation in any diagnosis position and inpatient or outpatient 
care setting:
2 codes for occurrence of ESRD/dialysis (either inpatient or outpatient), separated by at least 30 days:
ICD-9 Diagnosis: 585.6, V45.1, V56.0, V56.8, 585.5
ICD-9 Procedure: 39.95, 54.98 
ICD-10 Diagnosis:  N18.5, N18.6, Z49.31, Z49.32, Z99.2
ICD-10 Procedure: 3E1M39Z, 5A1D60Z, 5A1D00Z, 3E1M39Z, 5A1D60Z, 5A1D00Z
HCPCS/CPT codes: 50360, 50380, 90921, 90925, 90935, 90937, 90940, 90947, 90957, 90959, 90960, 90961, 90962, 
90966, 90969, 90989, 99512, G0257, G0318, G0319, G0322, G0326, S9335, S9339, 50365, 90920, 90924, 90945, 
90958, 90965, 90970, 90993, 90999, 99559, G0314, G0315, G0316, G0317, G0323, G0327
OR
Kidney transplant:
ICD-9 Diagnosis: 996.81, V42.0
ICD-9 Procedure: 55.6, 55.69
ICD-10 Diagnosis: T86.10, T86.13, T86.19, Z48.22, Z94.0, T86.11, T86.12
ICD-10 Procedure: 0TY00Z0, 0TY00Z2, 0TY10Z0, 0TY00Z1, 0TY10Z1, 0TY10Z2
HCPCS/CPT Code: 50360 50365
Patorno, Elisabetta et al. "Cardiovascular outcomes 
associated with canagliflozin versus other non-
gliflozin antidiabetic drugs: population based cohort 
study." BMJ 2018;360:k119 
http://dx.doi.org/10.1136/bmj.k119
Patorno, Elisabetta et al. "Empagliflozin and the 
Risk of Heart Failure Hospitalization in Routine 
Clinical Care: A First Analysis from the 
Empagliflozin Comparative Effectiveness and Safety 
(EMPRISE) Study."  Circulation. 2019 Apr 8. doi: 
10.1161/CIRCULATIONAHA.118.039177
14
End-Stage Liver Disease
Measured 180 days prior to and including day of drug initiation in any diagnosis position and inpatient or outpatient 
care setting:
Cirrhosis: 
ICD-9 Diagnosis: 571.2, 571.5, 571.6
ICD-10 Diagnosis: K70.11, K70.2, K70.3x, K70.4x, K74.x
Hepatic decompensation: 
ICD-9 Diagnosis: 456.0, 456.20, 456.1, 456.21, 789.5, 789.59, 572.2, 567.0, 567.2, 567.21, 567.22, 567.29, 567.8, 
567.89, 567.9, 572.4 
ICD-10 Diagnosis: R18.x, I85.x, K72.x, K65.x, K66.x, K67
HCC is already excluded with exclusion criteria 4
15
Blindness or compromised vision
Measured 180 days prior to and including day of drug initiation in any diagnosis position and inpatient or outpatient 
care setting:
ICD-9 Diagnosis: 369.x 
ICD-10 Diagnosis:  H54.x 
16
Abaloparatide
Measured  450 (1 year + 90 days) prior to the day of drug initiation:
Generic name:
Abaloparatide
17
Romosozumab
Measured  450 (1 year + 90 days) prior to the day of drug initiation:
Generic name:
Romosozumab
Appendix A

HIP AND FEMUR FRACTURES CODES
ICD9 Diagnosis codes (excluding rare fractures in young children) 
Fracture of neck of femur
820 Fracture of neck of femur
820.0 Closed fracture of intracapsular section
820.00 Closed fracture of intracapsular section of neck of femur, unspecified
820.02 Closed fracture of midcervical section of neck of femur
820.03 Closed fracture of base of neck of femur
820.09 Other closed transcervical fracture of neck of femur 
820.1 Open fracture of intracapsular section of neck of femur
820.10 Open fracture of intracapsular section of neck of femur, unspecified 
820.11 Open fracture of epiphysis (separation) (upper) of neck of femur 
820.12 Open fracture of midcervical section of neck of femur 
820.13 Open fracture of base of neck of femur 
820.19 Other open transcervical fracture of neck of femur
820.2 Closed fracture of trochanteric section
820.20 Closed fracture of trochanteric section of neck of femur 
820.21 Closed fracture of intertrochanteric section of neck of femur 
820.22 Closed fracture of subtrochanteric section of neck of femur
820.3 Open fracture of trochanteric section
820.30 Open fracture of trochanteric section of neck of femur, unspecified 
820.31 Open fracture of intertrochanteric section of neck of femur 
820.32 Open fracture of subtrochanteric section of neck of femur 
820.8 Closed fracture of unspecified part of neck of femur 
820.9 Open fracture of unspecified part of neck of femur 
Fracture of other and unspecified parts of femur
821 Closed fracture
821.0 Closed fracture of femur
821.00 Closed fracture of unspecified part of femur 
821.01 Closed fracture of shaft of femur convert
821.10 Open fracture of unspecified part of femur 
821.11 Open fracture of shaft of femur convert
821.20 Closed fracture of lower end of femur, unspecified part 
821.21 Closed fracture of condyle, femoral 
821.23 Closed supracondylar fracture of femur 
821.29 Other closed fracture of lower end of femur 
821.3 Open fracture of lower end of femur
821.30 Open fracture of lower end of femur, unspecified part 
821.31 Open fracture of condyle, femoral 
821.32 Open fracture of epiphysis. Lower (separation) of femur
821.33 Open supracondylar fracture of femur
821.39 Other open fracture of lower end of femur
HIP AND FEMUR FRACTURES
ICD10 Diagnosis codes (incident fracture - excluding subsequent encounter and sequela, and rare fractures in young children) 
 S72.0 Fracture of head and neck of femur (all)
 S72.00 Fracture of unspecified part of neck of femur
 S72.001 Fracture of unspecified part of neck of right femur
 S72.001A …… initial encounter for closed fracture
 S72.001B …… initial encounter for open fracture type I or II
 S72.001C …… initial encounter for open fracture type IIIA, IIIB, or IIIC
 S72.002 Fracture of unspecified part of neck of left femur
 S72.002A …… initial encounter for closed fracture
 S72.002B …… initial encounter for open fracture type I or II
 S72.002C …… initial encounter for open fracture type IIIA, IIIB, or IIIC
 S72.009 Fracture of unspecified part of neck of unspecified femur
 S72.009A …… initial encounter for closed fracture
Appendix A

 S72.009B …… initial encounter for open fracture type I or II
 S72.009C …… initial encounter for open fracture type IIIA, IIIB, or IIIC
 S72.01 Unspecified intracapsular fracture of femur
 S72.011 Unspecified intracapsular fracture of right femur
 S72.011A …… initial encounter for closed fracture
 S72.011B …… initial encounter for open fracture type I or II
 S72.011C …… initial encounter for open fracture type IIIA, IIIB, or IIIC
 S72.012 Unspecified intracapsular fracture of left femur
 S72.012A …… initial encounter for closed fracture
 S72.012B …… initial encounter for open fracture type I or II
 S72.012C …… initial encounter for open fracture type IIIA, IIIB, or IIIC
 S72.019 Unspecified intracapsular fracture of unspecified femur
 S72.019A …… initial encounter for closed fracture
 S72.019B …… initial encounter for open fracture type I or II
 S72.019C …… initial encounter for open fracture type IIIA, IIIB, or IIIC
 S72.021 Displaced fracture of epiphysis (separation) (upper) of right femur
 S72.021A …… initial encounter for closed fracture
 S72.021B …… initial encounter for open fracture type I or II
 S72.021C …… initial encounter for open fracture type IIIA, IIIB, or IIIC
 S72.022 Displaced fracture of epiphysis (separation) (upper) of left femur
 S72.022A …… initial encounter for closed fracture
 S72.022B …… initial encounter for open fracture type I or II
 S72.022C …… initial encounter for open fracture type IIIA, IIIB, or IIIC
 S72.023 Displaced fracture of epiphysis (separation) (upper) of unspecified femur
 S72.023A …… initial encounter for closed fracture
 S72.023B …… initial encounter for open fracture type I or II
 S72.023C …… initial encounter for open fracture type IIIA, IIIB, or IIIC
 S72.03 Midcervical fracture of femur
 S72.031 Displaced midcervical fracture of right femur
 S72.031A …… initial encounter for closed fracture
 S72.031B …… initial encounter for open fracture type I or II
 S72.031C …… initial encounter for open fracture type IIIA, IIIB, or IIIC
 S72.032 Displaced midcervical fracture of left femur
 S72.032A …… initial encounter for closed fracture
 S72.032B …… initial encounter for open fracture type I or II
 S72.032C …… initial encounter for open fracture type IIIA, IIIB, or IIIC
 S72.033 Displaced midcervical fracture of unspecified femur
 S72.033A …… initial encounter for closed fracture
 S72.033B …… initial encounter for open fracture type I or II
 S72.033C …… initial encounter for open fracture type IIIA, IIIB, or IIIC
 S72.034 Nondisplaced midcervical fracture of right femur
 S72.034A …… initial encounter for closed fracture
 S72.034B …… initial encounter for open fracture type I or II
 S72.034C …… initial encounter for open fracture type IIIA, IIIB, or IIIC
 S72.035 Nondisplaced midcervical fracture of left femur
 S72.035A …… initial encounter for closed fracture
 S72.035B …… initial encounter for open fracture type I or II
 S72.035C …… initial encounter for open fracture type IIIA, IIIB, or IIIC
 S72.036 Nondisplaced midcervical fracture of unspecified femur
 S72.036A …… initial encounter for closed fracture
 S72.036B …… initial encounter for open fracture type I or II
 S72.036C …… initial encounter for open fracture type IIIA, IIIB, or IIIC
 S72.04 Fracture of base of neck of femur
 S72.041 Displaced fracture of base of neck of right femur
 S72.041A …… initial encounter for closed fracture
 S72.041B …… initial encounter for open fracture type I or II
 S72.041C …… initial encounter for open fracture type IIIA, IIIB, or IIIC
 S72.042 Displaced fracture of base of neck of left femur
"QQFOEJY"

 S72.042A …… initial encounter for closed fracture
 S72.042B …… initial encounter for open fracture type I or II
 S72.042C …… initial encounter for open fracture type IIIA, IIIB, or IIIC
 S72.043 Displaced fracture of base of neck of unspecified femur
 S72.043A …… initial encounter for closed fracture
 S72.043B …… initial encounter for open fracture type I or II
 S72.043C …… initial encounter for open fracture type IIIA, IIIB, or IIIC
 S72.044 Nondisplaced fracture of base of neck of right femur
 S72.044A …… initial encounter for closed fracture
 S72.044B …… initial encounter for open fracture type I or II
 S72.044C …… initial encounter for open fracture type IIIA, IIIB, or IIIC
 S72.045 Nondisplaced fracture of base of neck of left femur
 S72.045A …… initial encounter for closed fracture
 S72.045B …… initial encounter for open fracture type I or II
 S72.045C …… initial encounter for open fracture type IIIA, IIIB, or IIIC
 S72.046 Nondisplaced fracture of base of neck of unspecified femur
 S72.046A …… initial encounter for closed fracture
 S72.046B …… initial encounter for open fracture type I or II
 S72.046C …… initial encounter for open fracture type IIIA, IIIB, or IIIC
 S72.05 Unspecified fracture of head of femur
 S72.051 Unspecified fracture of head of right femur
 S72.051A …… initial encounter for closed fracture
 S72.051B …… initial encounter for open fracture type I or II
 S72.051C …… initial encounter for open fracture type IIIA, IIIB, or IIIC
 S72.052 Unspecified fracture of head of left femur
 S72.052A …… initial encounter for closed fracture
 S72.052B …… initial encounter for open fracture type I or II
 S72.052C …… initial encounter for open fracture type IIIA, IIIB, or IIIC
 S72.059 Unspecified fracture of head of unspecified femur
 S72.059A …… initial encounter for closed fracture
 S72.059B …… initial encounter for open fracture type I or II
 S72.059C …… initial encounter for open fracture type IIIA, IIIB, or IIIC
 S72.06 Articular fracture of head of femur
 S72.061 Displaced articular fracture of head of right femur
 S72.061A …… initial encounter for closed fracture
 S72.061B …… initial encounter for open fracture type I or II
 S72.061C …… initial encounter for open fracture type IIIA, IIIB, or IIIC
 S72.062 Displaced articular fracture of head of left femur
 S72.062A …… initial encounter for closed fracture
 S72.062B …… initial encounter for open fracture type I or II
 S72.062C …… initial encounter for open fracture type IIIA, IIIB, or IIIC
 S72.063 Displaced articular fracture of head of unspecified femur
 S72.063A …… initial encounter for closed fracture
 S72.063B …… initial encounter for open fracture type I or II
 S72.063C …… initial encounter for open fracture type IIIA, IIIB, or IIIC
 S72.064 Nondisplaced articular fracture of head of right femur
 S72.064A …… initial encounter for closed fracture
 S72.064B …… initial encounter for open fracture type I or II
 S72.064C …… initial encounter for open fracture type IIIA, IIIB, or IIIC
 S72.065 Nondisplaced articular fracture of head of left femur
 S72.065A …… initial encounter for closed fracture
 S72.065B …… initial encounter for open fracture type I or II
 S72.065C …… initial encounter for open fracture type IIIA, IIIB, or IIIC
 S72.066 Nondisplaced articular fracture of head of unspecified femur
 S72.066A …… initial encounter for closed fracture
 S72.066B …… initial encounter for open fracture type I or II
 S72.066C …… initial encounter for open fracture type IIIA, IIIB, or IIIC
 S72.09 Other fracture of head and neck of femur
"QQFOEJY"

 S72.091 Other fracture of head and neck of right femur
 S72.091A …… initial encounter for closed fracture
 S72.091B …… initial encounter for open fracture type I or II
 S72.091C …… initial encounter for open fracture type IIIA, IIIB, or IIIC
 S72.092 Other fracture of head and neck of left femur
 S72.092A …… initial encounter for closed fracture
 S72.092B …… initial encounter for open fracture type I or II
 S72.092C …… initial encounter for open fracture type IIIA, IIIB, or IIIC
 S72.099 Other fracture of head and neck of unspecified femur
 S72.099A …… initial encounter for closed fracture
 S72.099B …… initial encounter for open fracture type I or II
 S72.099C …… initial encounter for open fracture type IIIA, IIIB, or IIIC
 S79.001A …… initial encounter for closed fracture
 S79.002A …… initial encounter for closed fracture
 S79.009A …… initial encounter for closed fracture
 S79.091A …… initial encounter for closed fracture
 S79.092A …… initial encounter for closed fracture
 S79.099A …… initial encounter for closed fracture
 S79.101A …… initial encounter for closed fracture
 S79.102A …… initial encounter for closed fracture
 S79.109A …… initial encounter for closed fracture
 S79.191A …… initial encounter for closed fracture
 S79.192A …… initial encounter for closed fracture
 S79.199A …… initial encounter for closed fracture
ICD9 Diagnosis Codes
Pathologic fracture
733.14Pathologic fracture of neck of femur 
733.15Pathologic fracture of other specified part of femur
ICD10 Diagnosis Codes
 M80 Osteoporosis with current pathological fracture
 M80.05 Age-related osteoporosis with current pathological fracture, femur
 M80.051 Age-related osteoporosis with current pathological fracture, right femur
 M80.051A …… initial encounter for fracture
 M80.052 Age-related osteoporosis with current pathological fracture, left femur
 M80.052A …… initial encounter for fracture
 M80.059 Age-related osteoporosis with current pathological fracture, unspecified femur
 M80.059A …… initial encounter for fracture
 M80.85 Other osteoporosis with current pathological fracture, femur
 M80.851 Other osteoporosis with current pathological fracture, right femur
 M80.851A …… initial encounter for fracture
 M80.852 Other osteoporosis with current pathological fracture, left femur
 M80.852A …… initial encounter for fracture
 M80.859 Other osteoporosis with current pathological fracture, unspecified femur
 M80.859A …… initial encounter for fracture
 M84.4 Pathological fracture, not elsewhere classified
 M84.45 Pathological fracture, femur and pelvis
 M84.451 Pathological fracture, right femur
 M84.451A…… initial encounter for fracture
 M84.452 Pathological fracture, left femur
 M84.452A…… initial encounter for fracture
 M84.453 Pathological fracture, unspecified femur
 M84.453A…… initial encounter for fracture
 M84.459 Pathological fracture, hip, unspecified
M84.459A…… initial encounter for fracture
 M84.6 Pathological fracture in other disease
 M84.651 Pathological fracture in other disease, right femur
M84.651A…… initial encounter for fracture
"QQFOEJY"

V54.13Aftercare for healing traumatic fracture of hip
V54.15Aftercare for healing traumatic fracture of upper leg
ICD9 Diagnosis Codes
 M84.652 Pathological fracture in other disease, left femur
M84.652A…… initial encounter for fracture
 M84.653 Pathological fracture in other disease, unspecified femur
M84.653A…… initial encounter for fracture
 M84.659 Pathological fracture in other disease, hip, unspecified
M84.659A…… initial encounter for fracture
 M84.7 Nontraumatic fracture, not elsewhere classified
 M84.75 Atypical femoral fracture
M84.750A…… initial encounter for fracture
 M84.751 Incomplete atypical femoral fracture, right leg
M84.751A…… initial encounter for fracture
 M84.752 Incomplete atypical femoral fracture, left leg
M84.752A…… initial encounter for fracture
 M84.753 Incomplete atypical femoral fracture, unspecified leg
M84.753A…… initial encounter for fracture
 M84.754 Complete transverse atypical femoral fracture, right leg
M84.754A…… initial encounter for fracture
 M84.755 Complete transverse atypical femoral fracture, left leg
M84.755A…… initial encounter for fracture
 M84.756 Complete transverse atypical femoral fracture, unspecified leg
M84.756A…… initial encounter for fracture
 M84.757 Complete oblique atypical femoral fracture, right leg
M84.757A…… initial encounter for fracture
 M84.758 Complete oblique atypical femoral fracture, left leg
M84.758A…… initial encounter for fracture
 M84.759 Complete oblique atypical femoral fracture, unspecified leg
M84.759A…… initial encounter for fracture
Fracture Aftercare
Fracture Aftercare
S72.001D  Fx unsp part of nk of r femr, subs for clos fx w routn heal 
S72.002D  Fx unsp part of nk of l femr, subs for clos fx w routn heal 
S72.009D  Fx unsp prt of nk of unsp femr, 7thD 
S72.011D  Unsp intracap fx right femur, subs for clos fx w routn heal 
S72.012D  Unsp intracap fx left femur, subs for clos fx w routn heal 
S72.019D  Unsp intracap fx unsp femur, subs for clos fx w routn heal 
S72.019E  Unsp intracap fx unsp femr, 7thE 
S72.021D  Disp fx of epiphy (separation) (upper) of r femr, 7thD 
S72.022D  Disp fx of epiphy (separation) (upper) of l femr, 7thD 
S72.023D  Disp fx of epiphy (separation) (upper) of unsp femr, 7thD 
S72.023E  Disp fx of epiphy (separation) (upper) of unsp femr, 7thE 
S72.024D  Nondisp fx of epiphy (separation) (upper) of r femr, 7thD 
S72.025D  Nondisp fx of epiphy (separation) (upper) of l femr, 7thD 
S72.026D  Nondisp fx of epiphy (separation) (upper) of unsp femr, 7thD 
S72.026E  Nondisp fx of epiphy (separation) (upper) of unsp femr, 7thE 
S72.031D  Displ midcervical fx r femur, subs for clos fx w routn heal 
S72.032D  Displ midcervical fx l femur, subs for clos fx w routn heal 
S72.033D  Displ midcervical fx unsp femr, 7thD 
S72.033E  Displ midcervical fx unsp femr, 7thE 
S72.034D  Nondisp midcervical fx r femr, subs for clos fx w routn heal 
S72.035D  Nondisp midcervical fx l femr, subs for clos fx w routn heal 
S72.036D  Nondisp midcervical fx unsp femr, 7thD 
S72.036E  Nondisp midcervical fx unsp femr, 7thE 
S72.041D  Disp fx of base of nk of r femr, 7thD 
ICD10 Diagnosis Codes
"QQFOEJY"

S72.042D  Disp fx of base of nk of l femr, 7thD 
S72.043D  Disp fx of base of nk of unsp femr, 7thD 
S72.043E  Disp fx of base of nk of unsp femr, 7thE 
S72.044D  Nondisp fx of base of nk of r femr, 7thD 
S72.045D  Nondisp fx of base of nk of l femr, 7thD 
S72.046D  Nondisp fx of base of nk of unsp femr, 7thD 
S72.046E  Nondisp fx of base of nk of unsp femr, 7thE 
S72.051D  Unsp fx head of right femur, subs for clos fx w routn heal 
S72.052D  Unsp fx head of left femur, subs for clos fx w routn heal 
S72.059D  Unsp fx head of unsp femur, subs for clos fx w routn heal 
S72.061D  Displ artic fx head of r femr, subs for clos fx w routn heal 
S72.062D  Displ artic fx head of l femr, subs for clos fx w routn heal 
S72.063D  Displ artic fx head of unsp femr, 7thD 
S72.064D  Nondisp artic fx head of r femr, 7thD 
S72.065D  Nondisp artic fx head of l femr, 7thD 
S72.066D  Nondisp artic fx head of unsp femr, 7thD 
S72.091D  Oth fx head/neck of r femur, subs for clos fx w routn heal 
S72.092D  Oth fx head/neck of l femur, subs for clos fx w routn heal 
S72.099D  Oth fx head/neck of unsp femr, subs for clos fx w routn heal 
S72.099E  Oth fx head/neck of unsp femr, 7thE 
S72.101D  Unsp trochan fx right femur, subs for clos fx w routn heal 
S72.102D  Unsp trochan fx left femur, subs for clos fx w routn heal 
S72.109D  Unsp trochan fx unsp femur, subs for clos fx w routn heal 
S72.109E  Unsp trochan fx unsp femr, 7thE 
S72.111D  Disp fx of greater trochanter of r femr, 7thD 
S72.112D  Disp fx of greater trochanter of l femr, 7thD 
S72.113D  Disp fx of greater trochanter of unsp femr, 7thD 
S72.114D  Nondisp fx of greater trochanter of r femr, 7thD 
S72.115D  Nondisp fx of greater trochanter of l femr, 7thD 
S72.116D  Nondisp fx of greater trochanter of unsp femr, 7thD 
S72.121D  Disp fx of less trochanter of r femr, 7thD 
S72.122D  Disp fx of less trochanter of l femr, 7thD 
S72.123D  Disp fx of less trochanter of unsp femr, 7thD 
S72.124D  Nondisp fx of less trochanter of r femr, 7thD 
S72.125D  Nondisp fx of less trochanter of l femr, 7thD 
S72.126D  Nondisp fx of less trochanter of unsp femr, 7thD 
S72.131D  Displ apophyseal fx r femur, subs for clos fx w routn heal 
S72.132D  Displ apophyseal fx l femur, subs for clos fx w routn heal 
S72.133D  Displ apophyseal fx unsp femr, subs for clos fx w routn heal 
S72.134D  Nondisp apophyseal fx r femur, subs for clos fx w routn heal 
S72.135D  Nondisp apophyseal fx l femur, subs for clos fx w routn heal 
S72.136D  Nondisp apophyseal fx unsp femr, 7thD 
S72.141D  Displ intertroch fx r femur, subs for clos fx w routn heal 
S72.142D  Displ intertroch fx l femur, subs for clos fx w routn heal 
S72.143D  Displ intertroch fx unsp femr, subs for clos fx w routn heal 
S72.144D  Nondisp intertroch fx r femur, subs for clos fx w routn heal 
S72.145D  Nondisp intertroch fx l femur, subs for clos fx w routn heal 
S72.146D  Nondisp intertroch fx unsp femr, 7thD 
Stress fracture
733.96 Stress fracture of femoral neck
733.97 Stress fracture of shaft of femur
ICD10 diagnosis Codes (M84.3xxx Stress fracture)
M84.351 Stress fracture, right femur
M84.351A …… initial encounter for fracture
M84.352 Stress fracture, left femur
M84.352A …… initial encounter for fracture
ICD9 Diagnosis Codes
"QQFOEJY"

M84.353 Stress fracture, unspecified femur
M84.353A …… initial encounter for fracture
M84.359 Stress fracture, hip, unspecified
M84.359A …… initial encounter for fracture
HIP AND FEMUR FRACTURES
ICD9 Procedure codes
78.55 Internal fixation of bone without fracture reduction, femur
79.05 Closed reduction of fracture without internal fixation, femur
79.15 Closed reduction of fracture with internal fixation, femur
79.25 Open reduction of fracture without internal fixation, femur
79.35 Open reduction of fracture with internal fixation, femur
79.65 Debridement of open fracture site, femur
815.1 Total hip replacement
815.2 Partial hip replacement
HIP AND FEMUR FRACTURES
 0QS6 Upper Femur, Right (ALL)
 0QS604Z Reposition Right Upper Femur with Internal Fixation Device, Open Approach
 0QS605Z Reposition Right Upper Femur with External Fixation Device, Open Approach
 0QS606Z Reposition Right Upper Femur with Intramedullary Internal Fixation Device, Open Approach
 0QS60BZ Reposition Right Upper Femur with Monoplanar External Fixation Device, Open Approach
 0QS60CZ Reposition Right Upper Femur with Ring External Fixation Device, Open Approach
 0QS60DZ Reposition Right Upper Femur with Hybrid External Fixation Device, Open Approach
 0QS60ZZ Reposition Right Upper Femur, Open Approach
 0QS634Z Reposition Right Upper Femur with Internal Fixation Device, Percutaneous Approach
 0QS635Z Reposition Right Upper Femur with External Fixation Device, Percutaneous Approach
 0QS636Z Reposition Right Upper Femur with Intramedullary Internal Fixation Device, Percutaneous Approach
 0QS63BZ Reposition Right Upper Femur with Monoplanar External Fixation Device, Percutaneous Approach
 0QS63CZ Reposition Right Upper Femur with Ring External Fixation Device, Percutaneous Approach
 0QS63DZ Reposition Right Upper Femur with Hybrid External Fixation Device, Percutaneous Approach
 0QS63ZZ Reposition Right Upper Femur, Percutaneous Approach
 0QS644Z Reposition Right Upper Femur with Internal Fixation Device, Percutaneous Endoscopic Approach
 0QS645Z Reposition Right Upper Femur with External Fixation Device, Percutaneous Endoscopic Approach
 0QS646Z Reposition Right Upper Femur with Intramedullary Internal Fixation Device, Percutaneous Endoscopic Approach
 0QS64BZ Reposition Right Upper Femur with Monoplanar External Fixation Device, Percutaneous Endoscopic Approach
 0QS64CZ Reposition Right Upper Femur with Ring External Fixation Device, Percutaneous Endoscopic Approach
 0QS64DZ Reposition Right Upper Femur with Hybrid External Fixation Device, Percutaneous Endoscopic Approach
 0QS64ZZ Reposition Right Upper Femur, Percutaneous Endoscopic Approach
 0QS6XZZ Reposition Right Upper Femur, External Approach
 0QS7 Upper Femur, Left (ALL)
 0QS704Z Reposition Left Upper Femur with Internal Fixation Device, Open Approach
 0QS705Z Reposition Left Upper Femur with External Fixation Device, Open Approach
 0QS706Z Reposition Left Upper Femur with Intramedullary Internal Fixation Device, Open Approach
 0QS70BZ Reposition Left Upper Femur with Monoplanar External Fixation Device, Open Approach
 0QS70CZ Reposition Left Upper Femur with Ring External Fixation Device, Open Approach
 0QS70DZ Reposition Left Upper Femur with Hybrid External Fixation Device, Open Approach
 0QS70ZZ Reposition Left Upper Femur, Open Approach
 0QS734Z Reposition Left Upper Femur with Internal Fixation Device, Percutaneous Approach
 0QS735Z Reposition Left Upper Femur with External Fixation Device, Percutaneous Approach
 0QS736Z Reposition Left Upper Femur with Intramedullary Internal Fixation Device, Percutaneous Approach
 0QS73BZ Reposition Left Upper Femur with Monoplanar External Fixation Device, Percutaneous Approach
 0QS73CZ Reposition Left Upper Femur with Ring External Fixation Device, Percutaneous Approach
 0QS73DZ Reposition Left Upper Femur with Hybrid External Fixation Device, Percutaneous Approach
 0QS73ZZ Reposition Left Upper Femur, Percutaneous Approach
 0QS744Z Reposition Left Upper Femur with Internal Fixation Device, Percutaneous Endoscopic Approach
 0QS745Z Reposition Left Upper Femur with External Fixation Device, Percutaneous Endoscopic Approach
REPOSITION
ICD10 Procedure codes
"QQFOEJY"

 0QS746Z Reposition Left Upper Femur with Intramedullary Internal Fixation Device, Percutaneous Endoscopic Approach
 0QS74BZ Reposition Left Upper Femur with Monoplanar External Fixation Device, Percutaneous Endoscopic Approach
 0QS74CZ Reposition Left Upper Femur with Ring External Fixation Device, Percutaneous Endoscopic Approach
 0QS74DZ Reposition Left Upper Femur with Hybrid External Fixation Device, Percutaneous Endoscopic Approach
 0QS74ZZ Reposition Left Upper Femur, Percutaneous Endoscopic Approach
 0QS7XZZ Reposition Left Upper Femur, External Approach
 0QS8 Femoral Shaft, Right (ALL)
 0QS804Z Reposition Right Femoral Shaft with Internal Fixation Device, Open Approach
 0QS805Z Reposition Right Femoral Shaft with External Fixation Device, Open Approach
 0QS806Z Reposition Right Femoral Shaft with Intramedullary Internal Fixation Device, Open Approach
 0QS80BZ Reposition Right Femoral Shaft with Monoplanar External Fixation Device, Open Approach
 0QS80CZ Reposition Right Femoral Shaft with Ring External Fixation Device, Open Approach
 0QS80DZ Reposition Right Femoral Shaft with Hybrid External Fixation Device, Open Approach
 0QS80ZZ Reposition Right Femoral Shaft, Open Approach
 0QS834Z Reposition Right Femoral Shaft with Internal Fixation Device, Percutaneous Approach
 0QS835Z Reposition Right Femoral Shaft with External Fixation Device, Percutaneous Approach
 0QS836Z Reposition Right Femoral Shaft with Intramedullary Internal Fixation Device, Percutaneous Approach
 0QS83BZ Reposition Right Femoral Shaft with Monoplanar External Fixation Device, Percutaneous Approach
 0QS83CZ Reposition Right Femoral Shaft with Ring External Fixation Device, Percutaneous Approach
 0QS83DZ Reposition Right Femoral Shaft with Hybrid External Fixation Device, Percutaneous Approach
 0QS83ZZ Reposition Right Femoral Shaft, Percutaneous Approach
 0QS844Z Reposition Right Femoral Shaft with Internal Fixation Device, Percutaneous Endoscopic Approach
 0QS845Z Reposition Right Femoral Shaft with External Fixation Device, Percutaneous Endoscopic Approach
 0QS846Z Reposition Right Femoral Shaft with Intramedullary Internal Fixation Device, Percutaneous Endoscopic Approach
 0QS84BZ Reposition Right Femoral Shaft with Monoplanar External Fixation Device, Percutaneous Endoscopic Approach
 0QS84CZ Reposition Right Femoral Shaft with Ring External Fixation Device, Percutaneous Endoscopic Approach
 0QS84DZ Reposition Right Femoral Shaft with Hybrid External Fixation Device, Percutaneous Endoscopic Approach
 0QS84ZZ Reposition Right Femoral Shaft, Percutaneous Endoscopic Approach
 0QS8XZZ Reposition Right Femoral Shaft, External Approach
0QS9 Femoral Shaft, Left (ALL)
 0QS904Z Reposition Left Femoral Shaft with Internal Fixation Device, Open Approach
 0QS905Z Reposition Left Femoral Shaft with External Fixation Device, Open Approach
 0QS906Z Reposition Left Femoral Shaft with Intramedullary Internal Fixation Device, Open Approach
 0QS90BZ Reposition Left Femoral Shaft with Monoplanar External Fixation Device, Open Approach
 0QS90CZ Reposition Left Femoral Shaft with Ring External Fixation Device, Open Approach
 0QS90DZ Reposition Left Femoral Shaft with Hybrid External Fixation Device, Open Approach
 0QS90ZZ Reposition Left Femoral Shaft, Open Approach
 0QS934Z Reposition Left Femoral Shaft with Internal Fixation Device, Percutaneous Approach
 0QS935Z Reposition Left Femoral Shaft with External Fixation Device, Percutaneous Approach
 0QS936Z Reposition Left Femoral Shaft with Intramedullary Internal Fixation Device, Percutaneous Approach
 0QS93BZ Reposition Left Femoral Shaft with Monoplanar External Fixation Device, Percutaneous Approach
 0QS93CZ Reposition Left Femoral Shaft with Ring External Fixation Device, Percutaneous Approach
 0QS93DZ Reposition Left Femoral Shaft with Hybrid External Fixation Device, Percutaneous Approach
 0QS93ZZ Reposition Left Femoral Shaft, Percutaneous Approach
 0QS944Z Reposition Left Femoral Shaft with Internal Fixation Device, Percutaneous Endoscopic Approach
 0QS945Z Reposition Left Femoral Shaft with External Fixation Device, Percutaneous Endoscopic Approach
 0QS946Z Reposition Left Femoral Shaft with Intramedullary Internal Fixation Device, Percutaneous Endoscopic Approach
 0QS94BZ Reposition Left Femoral Shaft with Monoplanar External Fixation Device, Percutaneous Endoscopic Approach
 0QS94CZ Reposition Left Femoral Shaft with Ring External Fixation Device, Percutaneous Endoscopic Approach
 0QS94DZ Reposition Left Femoral Shaft with Hybrid External Fixation Device, Percutaneous Endoscopic Approach
 0QS94ZZ Reposition Left Femoral Shaft, Percutaneous Endoscopic Approach
 0QS9XZZ Reposition Left Femoral Shaft, External Approach
 0QSB4ZZ Reposition Right Lower Femur, Percutaneous Endoscopic Approach
 0QSBXZZ Reposition Right Lower Femur, External Approach
 0QSB Lower Femur, Right (ALL)
 0QSB04Z Reposition Right Lower Femur with Internal Fixation Device, Open Approach
 0QSB05Z Reposition Right Lower Femur with External Fixation Device, Open Approach
 0QSB06Z Reposition Right Lower Femur with Intramedullary Internal Fixation Device, Open Approach
"QQFOEJY"

 0QSB0BZ Reposition Right Lower Femur with Monoplanar External Fixation Device, Open Approach
 0QSB0CZ Reposition Right Lower Femur with Ring External Fixation Device, Open Approach
 0QSB0DZ Reposition Right Lower Femur with Hybrid External Fixation Device, Open Approach
 0QSB0ZZ Reposition Right Lower Femur, Open Approach
 0QSB34Z Reposition Right Lower Femur with Internal Fixation Device, Percutaneous Approach
 0QSB35Z Reposition Right Lower Femur with External Fixation Device, Percutaneous Approach
 0QSB36Z Reposition Right Lower Femur with Intramedullary Internal Fixation Device, Percutaneous Approach
 0QSB3BZ Reposition Right Lower Femur with Monoplanar External Fixation Device, Percutaneous Approach
 0QSB3CZ Reposition Right Lower Femur with Ring External Fixation Device, Percutaneous Approach
 0QSB3DZ Reposition Right Lower Femur with Hybrid External Fixation Device, Percutaneous Approach
 0QSB3ZZ Reposition Right Lower Femur, Percutaneous Approach
 0QSB44Z Reposition Right Lower Femur with Internal Fixation Device, Percutaneous Endoscopic Approach
 0QSB45Z Reposition Right Lower Femur with External Fixation Device, Percutaneous Endoscopic Approach
 0QSB46Z Reposition Right Lower Femur with Intramedullary Internal Fixation Device, Percutaneous Endoscopic Approach
 0QSB4BZ Reposition Right Lower Femur with Monoplanar External Fixation Device, Percutaneous Endoscopic Approach
 0QSB4CZ Reposition Right Lower Femur with Ring External Fixation Device, Percutaneous Endoscopic Approach
 0QSB4DZ Reposition Right Lower Femur with Hybrid External Fixation Device, Percutaneous Endoscopic Approach
 0QSB4ZZ Reposition Right Lower Femur, Percutaneous Endoscopic Approach
 0QSBXZZ Reposition Right Lower Femur, External Approach
 0QSC Lower Femur, Left (all)
 0QSC04Z Reposition Left Lower Femur with Internal Fixation Device, Open Approach
 0QSC05Z Reposition Left Lower Femur with External Fixation Device, Open Approach
 0QSC06Z Reposition Left Lower Femur with Intramedullary Internal Fixation Device, Open Approach
 0QSC0BZ Reposition Left Lower Femur with Monoplanar External Fixation Device, Open Approach
 0QSC0CZ Reposition Left Lower Femur with Ring External Fixation Device, Open Approach
 0QSC0DZ Reposition Left Lower Femur with Hybrid External Fixation Device, Open Approach
 0QSC0ZZ Reposition Left Lower Femur, Open Approach
 0QSC34Z Reposition Left Lower Femur with Internal Fixation Device, Percutaneous Approach
 0QSC35Z Reposition Left Lower Femur with External Fixation Device, Percutaneous Approach
 0QSC36Z Reposition Left Lower Femur with Intramedullary Internal Fixation Device, Percutaneous Approach
 0QSC3BZ Reposition Left Lower Femur with Monoplanar External Fixation Device, Percutaneous Approach
 0QSC3CZ Reposition Left Lower Femur with Ring External Fixation Device, Percutaneous Approach
 0QSC3DZ Reposition Left Lower Femur with Hybrid External Fixation Device, Percutaneous Approach
 0QSC3ZZ Reposition Left Lower Femur, Percutaneous Approach
 0QSC44Z Reposition Left Lower Femur with Internal Fixation Device, Percutaneous Endoscopic Approach
 0QSC45Z Reposition Left Lower Femur with External Fixation Device, Percutaneous Endoscopic Approach
 0QSC46Z Reposition Left Lower Femur with Intramedullary Internal Fixation Device, Percutaneous Endoscopic Approach
 0QSC4BZ Reposition Left Lower Femur with Monoplanar External Fixation Device, Percutaneous Endoscopic Approach
 0QSC4CZ Reposition Left Lower Femur with Ring External Fixation Device, Percutaneous Endoscopic Approach
 0QSC4DZ Reposition Left Lower Femur with Hybrid External Fixation Device, Percutaneous Endoscopic Approach
 0QSC4ZZ Reposition Left Lower Femur, Percutaneous Endoscopic Approach
 0QSCXZZ Reposition Left Lower Femur, External Approach
 0QH6 Upper Femur, Right (ALL)
 0QH604Z Insertion of Internal Fixation Device into Right Upper Femur, Open Approach
 0QH605Z Insertion of External Fixation Device into Right Upper Femur, Open Approach
 0QH606Z Insertion of Intramedullary Internal Fixation Device into Right Upper Femur, Open Approach
 0QH608Z Insertion of Limb Lengthening External Fixation Device into Right Upper Femur, Open Approach
 0QH60BZ Insertion of Monoplanar External Fixation Device into Right Upper Femur, Open Approach
 0QH60CZ Insertion of Ring External Fixation Device into Right Upper Femur, Open Approach
 0QH60DZ Insertion of Hybrid External Fixation Device into Right Upper Femur, Open Approach
 0QH634Z Insertion of Internal Fixation Device into Right Upper Femur, Percutaneous Approach
 0QH635Z Insertion of External Fixation Device into Right Upper Femur, Percutaneous Approach
 0QH636Z Insertion of Intramedullary Internal Fixation Device into Right Upper Femur, Percutaneous Approach
 0QH638Z Insertion of Limb Lengthening External Fixation Device into Right Upper Femur, Percutaneous Approach
 0QH63BZ Insertion of Monoplanar External Fixation Device into Right Upper Femur, Percutaneous Approach
 0QH63CZ Insertion of Ring External Fixation Device into Right Upper Femur, Percutaneous Approach
INSERTION
"QQFOEJY"

 0QH63DZ Insertion of Hybrid External Fixation Device into Right Upper Femur, Percutaneous Approach
 0QH644Z Insertion of Internal Fixation Device into Right Upper Femur, Percutaneous Endoscopic Approach
 0QH645Z Insertion of External Fixation Device into Right Upper Femur, Percutaneous Endoscopic Approach
 0QH646Z Insertion of Intramedullary Internal Fixation Device into Right Upper Femur, Percutaneous Endoscopic Approach
 0QH648Z Insertion of Limb Lengthening External Fixation Device into Right Upper Femur, Percutaneous Endoscopic Approach
 0QH64BZ Insertion of Monoplanar External Fixation Device into Right Upper Femur, Percutaneous Endoscopic Approach
 0QH64CZ Insertion of Ring External Fixation Device into Right Upper Femur, Percutaneous Endoscopic Approach
 0QH64DZ Insertion of Hybrid External Fixation Device into Right Upper Femur, Percutaneous Endoscopic Approach
0QHC Lower Femur, Left (all)
 0QH704Z Insertion of Internal Fixation Device into Left Upper Femur, Open Approach
 0QH705Z Insertion of External Fixation Device into Left Upper Femur, Open Approach
 0QH706Z Insertion of Intramedullary Internal Fixation Device into Left Upper Femur, Open Approach
 0QH708Z Insertion of Limb Lengthening External Fixation Device into Left Upper Femur, Open Approach
 0QH70BZ Insertion of Monoplanar External Fixation Device into Left Upper Femur, Open Approach
 0QH70CZ Insertion of Ring External Fixation Device into Left Upper Femur, Open Approach
 0QH70DZ Insertion of Hybrid External Fixation Device into Left Upper Femur, Open Approach
 0QH734Z Insertion of Internal Fixation Device into Left Upper Femur, Percutaneous Approach
 0QH735Z Insertion of External Fixation Device into Left Upper Femur, Percutaneous Approach
 0QH736Z Insertion of Intramedullary Internal Fixation Device into Left Upper Femur, Percutaneous Approach
 0QH738Z Insertion of Limb Lengthening External Fixation Device into Left Upper Femur, Percutaneous Approach
 0QH73BZ Insertion of Monoplanar External Fixation Device into Left Upper Femur, Percutaneous Approach
 0QH73CZ Insertion of Ring External Fixation Device into Left Upper Femur, Percutaneous Approach
 0QH73DZ Insertion of Hybrid External Fixation Device into Left Upper Femur, Percutaneous Approach
 0QH744Z Insertion of Internal Fixation Device into Left Upper Femur, Percutaneous Endoscopic Approach
 0QH745Z Insertion of External Fixation Device into Left Upper Femur, Percutaneous Endoscopic Approach
 0QH746Z Insertion of Intramedullary Internal Fixation Device into Left Upper Femur, Percutaneous Endoscopic Approach
 0QH748Z Insertion of Limb Lengthening External Fixation Device into Left Upper Femur, Percutaneous Endoscopic Approach
 0QH74BZ Insertion of Monoplanar External Fixation Device into Left Upper Femur, Percutaneous Endoscopic Approach
 0QH74CZ Insertion of Ring External Fixation Device into Left Upper Femur, Percutaneous Endoscopic Approach
 0QH74DZ Insertion of Hybrid External Fixation Device into Left Upper Femur, Percutaneous Endoscopic Approach
 0QH8 Femoral Shaft, Right (all)
 0QH804Z Insertion of Internal Fixation Device into Right Femoral Shaft, Open Approach
 0QH805Z Insertion of External Fixation Device into Right Femoral Shaft, Open Approach
 0QH806Z Insertion of Intramedullary Internal Fixation Device into Right Femoral Shaft, Open Approach
 0QH807Z Insertion of Intramedullary Limb Lengthening Internal Fixation Device into Right Femoral Shaft, Open Approach
 0QH808Z Insertion of Limb Lengthening External Fixation Device into Right Femoral Shaft, Open Approach
 0QH80BZ Insertion of Monoplanar External Fixation Device into Right Femoral Shaft, Open Approach
 0QH80CZ Insertion of Ring External Fixation Device into Right Femoral Shaft, Open Approach
 0QH80DZ Insertion of Hybrid External Fixation Device into Right Femoral Shaft, Open Approach
 0QH834Z Insertion of Internal Fixation Device into Right Femoral Shaft, Percutaneous Approach
 0QH835Z Insertion of External Fixation Device into Right Femoral Shaft, Percutaneous Approach
 0QH836Z Insertion of Intramedullary Internal Fixation Device into Right Femoral Shaft, Percutaneous Approach
 0QH837Z Insertion of Intramedullary Limb Lengthening Internal Fixation Device into Right Femoral Shaft, Percutaneous Approach
 0QH838Z Insertion of Limb Lengthening External Fixation Device into Right Femoral Shaft, Percutaneous Approach
 0QH83BZ Insertion of Monoplanar External Fixation Device into Right Femoral Shaft, Percutaneous Approach
 0QH83CZ Insertion of Ring External Fixation Device into Right Femoral Shaft, Percutaneous Approach
 0QH83DZ Insertion of Hybrid External Fixation Device into Right Femoral Shaft, Percutaneous Approach
 0QH844Z Insertion of Internal Fixation Device into Right Femoral Shaft, Percutaneous Endoscopic Approach
 0QH845Z Insertion of External Fixation Device into Right Femoral Shaft, Percutaneous Endoscopic Approach
 0QH846Z Insertion of Intramedullary Internal Fixation Device into Right Femoral Shaft, Percutaneous Endoscopic Approach
 0QH847Z Insertion of Intramedullary Limb Lengthening Internal Fixation Device into Right Femoral Shaft, Percutaneous Endoscopic Approach
 0QH848Z Insertion of Limb Lengthening External Fixation Device into Right Femoral Shaft, Percutaneous Endoscopic Approach
 0QH84BZ Insertion of Monoplanar External Fixation Device into Right Femoral Shaft, Percutaneous Endoscopic Approach
 0QH84CZ Insertion of Ring External Fixation Device into Right Femoral Shaft, Percutaneous Endoscopic Approach
 0QH84DZ Insertion of Hybrid External Fixation Device into Right Femoral Shaft, Percutaneous Endoscopic Approach
0QH9 Femoral Shaft, Left (all)
 0QH904Z Insertion of Internal Fixation Device into Left Femoral Shaft, Open Approach
 0QH905Z Insertion of External Fixation Device into Left Femoral Shaft, Open Approach
"QQFOEJY"

 0QH906Z Insertion of Intramedullary Internal Fixation Device into Left Femoral Shaft, Open Approach
 0QH907Z Insertion of Intramedullary Limb Lengthening Internal Fixation Device into Left Femoral Shaft, Open Approach
 0QH908Z Insertion of Limb Lengthening External Fixation Device into Left Femoral Shaft, Open Approach
 0QH90BZ Insertion of Monoplanar External Fixation Device into Left Femoral Shaft, Open Approach
 0QH90CZ Insertion of Ring External Fixation Device into Left Femoral Shaft, Open Approach
 0QH90DZ Insertion of Hybrid External Fixation Device into Left Femoral Shaft, Open Approach
 0QH934Z Insertion of Internal Fixation Device into Left Femoral Shaft, Percutaneous Approach
 0QH935Z Insertion of External Fixation Device into Left Femoral Shaft, Percutaneous Approach
 0QH936Z Insertion of Intramedullary Internal Fixation Device into Left Femoral Shaft, Percutaneous Approach
 0QH937Z Insertion of Intramedullary Limb Lengthening Internal Fixation Device into Left Femoral Shaft, Percutaneous Approach
 0QH938Z Insertion of Limb Lengthening External Fixation Device into Left Femoral Shaft, Percutaneous Approach
 0QH93BZ Insertion of Monoplanar External Fixation Device into Left Femoral Shaft, Percutaneous Approach
 0QH93CZ Insertion of Ring External Fixation Device into Left Femoral Shaft, Percutaneous Approach
 0QH93DZ Insertion of Hybrid External Fixation Device into Left Femoral Shaft, Percutaneous Approach
 0QH944Z Insertion of Internal Fixation Device into Left Femoral Shaft, Percutaneous Endoscopic Approach
 0QH945Z Insertion of External Fixation Device into Left Femoral Shaft, Percutaneous Endoscopic Approach
 0QH946Z Insertion of Intramedullary Internal Fixation Device into Left Femoral Shaft, Percutaneous Endoscopic Approach
 0QH947Z Insertion of Intramedullary Limb Lengthening Internal Fixation Device into Left Femoral Shaft, Percutaneous Endoscopic Approach
 0QH948Z Insertion of Limb Lengthening External Fixation Device into Left Femoral Shaft, Percutaneous Endoscopic Approach
 0QH94BZ Insertion of Monoplanar External Fixation Device into Left Femoral Shaft, Percutaneous Endoscopic Approach
 0QH94CZ Insertion of Ring External Fixation Device into Left Femoral Shaft, Percutaneous Endoscopic Approach
 0QH94DZ Insertion of Hybrid External Fixation Device into Left Femoral Shaft, Percutaneous Endoscopic Approach
 0QHB Lower Femur, Right (all)
 0QHB04Z Insertion of Internal Fixation Device into Right Lower Femur, Open Approach
 0QHB05Z Insertion of External Fixation Device into Right Lower Femur, Open Approach
0QHB06Z nsertion of Intramedullary Internal Fixation Device into Right Lower Femur, Open Approach
0QHB08Z nsertion of Limb Lengthening External Fixation Device into Right Lower Femur, Open Approach
 0QHB0BZ Insertion of Monoplanar External Fixation Device into Right Lower Femur, Open Approach
 0QHB0CZ Insertion of Ring External Fixation Device into Right Lower Femur, Open Approach
0QHB0DZ Insertion of Hybrid External Fixation Device into Right Lower Femur, Open Approach
 0QHB34Z Insertion of Internal Fixation Device into Right Lower Femur, Percutaneous Approach
 0QHB35Z Insertion of External Fixation Device into Right Lower Femur, Percutaneous Approach
 0QHB36Z Insertion of Intramedullary Internal Fixation Device into Right Lower Femur, Percutaneous Approach
0QHB38ZInsertion of Limb Lengthening External Fixation Device into Right Lower Femur, Percutaneous Approach
 0QHB3BZ Insertion of Monoplanar External Fixation Device into Right Lower Femur, Percutaneous Approach
 0QHB3CZ Insertion of Ring External Fixation Device into Right Lower Femur, Percutaneous Approach
 0QHB3DZ Insertion of Hybrid External Fixation Device into Right Lower Femur, Percutaneous Approach
 0QHB44Z Insertion of Internal Fixation Device into Right Lower Femur, Percutaneous Endoscopic Approach
 0QHB45Z Insertion of External Fixation Device into Right Lower Femur, Percutaneous Endoscopic Approach
 0QHB46Z Insertion of Intramedullary Internal Fixation Device into Right Lower Femur, Percutaneous Endoscopic Approach
 0QHB48Z Insertion of Limb Lengthening External Fixation Device into Right Lower Femur, Percutaneous Endoscopic Approach
 0QHB4BZ Insertion of Monoplanar External Fixation Device into Right Lower Femur, Percutaneous Endoscopic Approach
 0QHB4CZ Insertion of Ring External Fixation Device into Right Lower Femur, Percutaneous Endoscopic Approach
0QHB4DZ Insertion of Hybrid External Fixation Device into Right Lower Femur, Percutaneous Endoscopic Approach
 0QHC Lower Femur, Left (all)
0QHC04ZInsertion of Internal Fixation Device into Left Lower Femur, Open Approach
0QHC05ZInsertion of External Fixation Device into Left Lower Femur, Open Approach
0QHC06ZInsertion of Intramedullary Internal Fixation Device into Left Lower Femur, Open Approach
0QHC08ZInsertion of Limb Lengthening External Fixation Device into Left Lower Femur, Open Approach
0QHC0BZInsertion of Monoplanar External Fixation Device into Left Lower Femur, Open Approach
0QHC0CZInsertion of Ring External Fixation Device into Left Lower Femur, Open Approach
0QHC0DZInsertion of Hybrid External Fixation Device into Left Lower Femur, Open Approach
0QHC34ZInsertion of Internal Fixation Device into Left Lower Femur, Percutaneous Approach
0QHC35ZInsertion of External Fixation Device into Left Lower Femur, Percutaneous Approach
0QHC36ZInsertion of Intramedullary Internal Fixation Device into Left Lower Femur, Percutaneous Approach
0QHC38ZInsertion of Limb Lengthening External Fixation Device into Left Lower Femur, Percutaneous Approach
0QHC3BZInsertion of Monoplanar External Fixation Device into Left Lower Femur, Percutaneous Approach
0QHC3CZInsertion of Ring External Fixation Device into Left Lower Femur, Percutaneous Approach
"QQFOEJY"

27125Hemiarthroplasty, hip, partial (eg, femoral stem prosthesis, bipolar arthroplasty)
27130Arthroplasty, acetabular and proximal femoral prosthetic replacement (total hip arthroplasty), with or without autograft por allograft
27220Closed treatment of acetabulum (hip socket) fracture(s)
27222Closed treatment of acetabulum (hip socket) fracture(s)
27226Fracture and/or Dislocation Procedures on the Pelvis and Hip Joint
27227Fracture and/or Dislocation Procedures on the Pelvis and Hip Joint
27228Fracture and/or Dislocation Procedures on the Pelvis and Hip Joint
27230Closed treatment of femoral fracture, proximal end, neck; without manipulation
27232Closed treatment of femoral fracture, proximal end, neck; with manipulation, with or without skeletal traction
27235Percutaneous skeletal fixation of femoral fracture, proximal end, neck
27236Open treatment of femoral fracture, proximal end, neck, internal fixation or prosthetic replacement
27238Closed treatment of intertrochanteric, peritrochanteric, or subtrochanteric femoral fracture; without manipulation
27240Closed treatment of intertrochanteric, peritrochanteric, or subtrochanteric femoral fracture; with manipulation, with or without skin or skeletal traction
27245Treatment of intertrochanteric, peritrochanteric, or subtrochanteric femoral fracture
27244Treatment of intertrochanteric, peritrochanteric, or subtrochanteric femoral fracture; with plate/screw type implant, with or without cerclage
27246Closed treatment of greater trochanteric fracture, without manipulation
27248Open treatment of greater trochanteric fracture, includes internal fixation, when performed
27254Fracture Procedures on the Pelvis and Hip Joint
27267Closed treatment of femoral fracture, proximal end, head; without manipulation
27268Closed treatment of femoral fracture, proximal end, head; with manipulation
27269Open treatment of femoral fracture, proximal end, head, includes internal fixation, when performed
27500Fracture Procedures on the Femur (Thigh Region) and Knee Joint
27501Fracture Procedures on the Femur (Thigh Region) and Knee Joint
27502Fracture Procedures on the Femur (Thigh Region) and Knee Joint
27503Fracture Procedures on the Femur (Thigh Region) and Knee Joint
27506Fracture Procedures on the Femur (Thigh Region) and Knee Joint
27507Fracture Procedures on the Femur (Thigh Region) and Knee Joint
27508Fracture Procedures on the Femur (Thigh Region) and Knee Joint
27509Fracture Procedures on the Femur (Thigh Region) and Knee Joint
27510Fracture Procedures on the Femur (Thigh Region) and Knee Joint
27511Fracture Procedures on the Femur (Thigh Region) and Knee Joint
27513Fracture Procedures on the Femur (Thigh Region) and Knee Joint
27514Fracture Procedures on the Femur (Thigh Region) and Knee Joint
0QHC3DZInsertion of Hybrid External Fixation Device into Left Lower Femur, Percutaneous Approach
0QHC44ZInsertion of Internal Fixation Device into Left Lower Femur, Percutaneous Endoscopic Approach
0QHC45ZInsertion of External Fixation Device into Left Lower Femur, Percutaneous Endoscopic Approach
0QHC46ZInsertion of Intramedullary Internal Fixation Device into Left Lower Femur, Percutaneous Endoscopic A
0QHC48ZInsertion of Limb Lengthening External Fixation Device into Left Lower Femur, Percutaneous Endoscopic
0QHC4BZInsertion of Monoplanar External Fixation Device into Left Lower Femur, Percutaneous Endoscopic Appro
0QHC4CZInsertion of Ring External Fixation Device into Left Lower Femur, Percutaneous Endoscopic Approach
0QHC4DZInsertion of Hybrid External Fixation Device into Left Lower Femur, Percutaneous Endoscopic Approach
HIP AND FEMUR FRACTURES
HCPCS/CPT codes
"QQFOEJY"

Pregnancy 
650   NORMAL DELIVERY
660   OBSTRUCTED LABOR
661   ABNORMALITY OF FORCES OF LABOR
662   LONG LABOR
663   UMBILICAL CORD COMPLICATIONS DURING LABOR AND DELIVERY
664   TRAUMA TO PERINEUM AND VULVA DURING DELIVERY
665   OTHER OBSTETRICAL TRAUMA
667   RETAINED PLACENTA OR MEMBRANES WITHOUT HEMORRHAGE
668   COMPLICATIONS OF THE ADMINISTRATION OF ANESTHETIC OR OTHER SEDATION IN LABOR AND DELIVERY
669.94   UNSPECIFIED COMPLICATION OF LABOR AND DELIVERY POSTPARTUM CONDITION OR COMPLICATION
V24   POSTPARTUM CARE AND EXAMINATION
V24.0   POSTPARTUM CARE AND EXAMINATION IMMEDIATELY AFTER DELIVERY
V24.1   POSTPARTUM CARE AND EXAMINATION OF LACTATING MOTHER
V24.2   ROUTINE POSTPARTUM FOLLOW
V27   OUTCOME OF DELIVERY
V27.0   MOTHER WITH SINGLE LIVEBORN
V27.1   MOTHER WITH SINGLE STILLBORN
V27.2   MOTHER WITH TWINS BOTH LIVEBORN
V27.3   MOTHER WITH TWINS ONE LIVEBORN AND ONE STILLBORN
V27.4   MOTHER WITH TWINS BOTH STILLBORN
V27.5   MOTHER WITH OTHER MULTIPLE BIRTH ALL LIVEBORN
V27.6   MOTHER WITH OTHER MULTIPLE BIRTH SOME LIVEBORN
V27.7   MOTHER WITH OTHER MULTIPLE BIRTH ALL STILLBORN
V27.9   MOTHER WITH UNSPECIFIED OUTCOME OF DELIVERY
Diagnosis Codes
Procedure Codes
72.0   LOW FORCEPS OPERATION
72.1   LOW FORCEPS OPERATION WITH EPISIOTOMY
72.2   MID FORCEPS OPERATION
72.21   MID FORCEPS OPERATION WITH EPISIOTOMY
72.29   OTHER MID FORCEPS OPERATION
72.3   HIGH FORCEPS OPERATION
72.31   HIGH FORCEPS OPERATION WITH EPISIOTOMY
Appendix A

72.39   OTHER HIGH FORCEPS OPERATION
72.4   FORCEPS ROTATION OF FETAL HEAD
72.5   BREECH EXTRACTION
72.51   PARTIAL BREECH EXTRACTION WITH FORCEPS TO AFTERCOMING HEAD
72.52   OTHER PARTIAL BREECH EXTRACTION
72.53   TOTAL BREECH EXTRACTION WITH FORCEPS TO AFTERCOMING HEAD
72.54   OTHER TOTAL BREECH EXTRACTION
72.6   FORCEPS APPLICATION TO AFTERCOMING HEAD
72.7   VACUUM EXTRACTION
72.71   VACUUM EXTRACTION WITH EPISIOTOMY
72.79   OTHER VACUUM EXTRACTION
72.8   OTHER SPECIFIED INSTRUMENTAL DELIVERY
72.9   UNSPECIFIED INSTRUMENTAL DELIVERY
73.0   ARTIFICIAL RUPTURE OF MEMBRANES
73.01   INDUCTION OF LABOR BY ARTIFICIAL RUPTURE OF MEMBRANES
73.09   OTHER ARTIFICIAL RUPTURE OF MEMBRANES
73.1   OTHER SURGICAL INDUCTION OF LABOR
73.2   INTERNAL AND COMBINED VERSION AND EXTRACTION
73.21   INTERNAL AND COMBINED VERSION WITHOUT EXTRACTION
73.22   INTERNAL AND COMBINED VERSION WITH EXTRACTION
73.3   FAILED FORCEPS
73.4   MEDICAL INDUCTION OF LABOR
73.5   MANUALLY ASSISTED DELIVERY
73.51   MANUAL ROTATION OF FETAL HEAD
73.59   OTHER MANUALLY ASSISTED DELIVERY
73.6   EPISIOTOMY
73.8   OPERATIONS ON FETUS TO FACILITATE DELIVERY
73.9   OTHER OPERATIONS ASSISTING DELIVERY
73.91   EXTERNAL VERSION ASSISTING DELIVERY
73.92   REPLACEMENT OF PROLAPSED UMBILICAL CORD
73.93   INCISION OF CERVIX TO ASSIST DELIVERY
73.94   PUBIOTOMY TO ASSIST DELIVERY
73.99   OTHER OPERATIONS ASSISTING DELIVERY
74.0   CLASSICAL CESAREAN SECTION
74.1   LOW CERVICAL CESAREAN SECTION
Appendix A

74.2   EXTRAPERITONEAL CESAREAN SECTION
74.3   REMOVAL OF EXTRATUBAL ECTOPIC PREGNANCY
74.4   CESAREAN SECTION OF OTHER SPECIFIED TYPE
74.9   CESAREAN SECTION OF UNSPECIFIED TYPE
74.91   HYSTEROTOMY TO TERMINATE PREGNANCY
74.99   OTHER CESAREAN SECTION OF UNSPECIFIED TYPE
75.4   MANUAL REMOVAL OF RETAINED PLACENTA
75.5   REPAIR OF CURRENT OBSTETRIC LACERATION OF UTERUS
75.6   REPAIR OF OTHER CURRENT OBSTETRIC LACERATION
75.7   MANUAL EXPLORATION OF UTERINE CAVITY, POSTPARTUM
75.9   OTHER OBSTETRIC OPERATIONS
"QQFOEJY"

AFTER PS MATCHING
Optum
MarketScan
BEFORE PS MATCHING
The c-statistics for the propensity score model, pre-matching was 0.803. 
The postmatching c-statistic was 0.533
The c-statistics for the propensity score model, pre-matching was 0.714. 
The postmatching c-statistic was 0.526.
Appendix B

Variable
Raloxifene
Zoledronic Acid
St. Diff.
Raloxifene
Zoledronic Acid
St. Diff.
Raloxifene
Zoledronic Acid
St. Diff.
Number of patients
6,815
6,605
6,694
13,997
13,509 
20,602 
Demographic characteristics
6,812 
5,344 
6,691 
13,208 
13,503 
18,552 
Age
...mean (sd)
73.41 (5.90)
74.02 (5.52)
-0.107
73.81 (7.06)
75.61 (7.14)
-0.254
73.61 (6.50)
75.15 (6.71)
-0.233
...median [IQR]
73.00 [68.00, 78.00]
75.00 [69.00, 79.00]
-0.350
72.00 [68.00, 79.00]
75.00 [70.00, 81.00]
-0.423
72.50 (6.50)
75.00 (6.71)
-0.378
Age categories
...< 70; n (%)
2,138 (31.4%)
1,714 (26.0%)
0.010
2,366 (35.3%)
3,498 (25.0%)
0.019
4,504 (33.4%)
5,212 (28.1%)
0.115
...70 - 74; n (%)
1,773 (26.0%)
1,575 (23.8%)
0.004
1,604 (24.0%)
3,134 (22.4%)
0.003
3,377 (25.0%)
4,709 (25.4%)
-0.009
...>= 75; n (%)
2,904 (42.6%)
3,316 (50.2%)
-0.011
2,724 (40.7%)
7,365 (52.6%)
-0.017
5,628 (41.7%)
10,681 (57.6%)
-0.322
Region
...Northeast; n (%)
1,052 (15.4%)
609 (9.2%)
0.018
1,226 (18.3%)
2,138 (15.3%)
0.007
2,278 (16.9%)
2,747 (14.8%)
0.058
...South; n (%)
2,873 (42.2%)
2,838 (43.0%)
-0.001
2,225 (33.2%)
4,693 (33.5%)
-0.001
5,098 (37.8%)
7,531 (40.6%)
-0.057
...Midwest; n (%)
776 (11.4%)
1,623 (24.6%)
-0.031
2,183 (32.6%)
5,245 (37.5%)
-0.008
2,959 (21.9%)
6,868 (37.0%)
-0.336
...West; n (%)
2,114 (31.0%)
1,535 (23.2%)
0.015
1,060 (15.8%)
1,921 (13.8%)
0.005
3,174 (23.5%)
3,456 (18.6%)
0.120
Calendar Time
...Aug 2007 - Aug 2010; n (%)
1,729 (25.4%)
2,334 (35.3%)
-0.018
2,398 (35.8%)
3,308 (23.6%)
0.022
4,127 (30.6%)
5,642 (30.4%)
0.004
...Aug 2010 - Aug 2013; n (%)
1,436 (21.1%)
3,541 (53.6%)
-0.053
2,163 (32.3%)
5,934 (42.4%)
-0.017
3,599 (26.7%)
9,475 (51.1%)
-0.517
...Aug 2013 - Aug 2016; n (%)
1,570 (23.0%)
286 (4.3%)
0.051
1,587 (23.7%)
3,512 (25.1%)
-0.003
3,157 (23.4%)
3,798 (20.5%)
0.070
...Aug 2016 - Mar 2020; n (%)
2,080 (30.5%)
444 (6.7%)
0.055
546 (8.2%)
1,243 (8.9%)
-0.002
2,626 (19.4%)
1,687 (9.1%)
0.298
Metropolitan Statistical Area
...Urban; n (%)
N/A
N/A
N/A
5,124 (76.5%)
10,520 (75.2%)
0.001
5,122 (76.6%)
9,932 (75.2%)
0.002
...Rural; n (%)
N/A
N/A
N/A
94 (1.4%)
256 (1.8%)
-0.003
94 (1.4%)
246 (1.9%)
-0.004
...Unknown/Missing; n (%)
N/A
N/A
N/A
1,476 (22.0%)
3,221 (23.0%)
-0.002
1,475 (22.0%)
3,030 (22.9%)
-0.002
General Health Related Measures
Smoking; n (%)
525 (7.7%)
588 (8.9%)
-0.004
257 (3.8%)
800 (5.7%)
-0.009
782 (5.8%)
1,388 (7.5%)
-0.068
Alcohol/Drug abuse or dependence ; n (%)
21 (0.3%)
15 (0.2%)
0.002
5 (0.1%)
22 (0.2%)
-0.003
026 (0.2%)
037 (0.2%)
0.000
Obesity or Overweight; n (%)
770 (11.3%)
371 (5.6%)
0.020
277 (4.1%)
723 (5.2%)
-0.005
1,047 (7.8%)
1,094 (5.9%)
0.075
   Obesity; n (%)
416 (6.1%)
277 (4.2%)
0.008
167 (2.5%)
509 (3.6%)
-0.006
583 (4.3%)
786 (4.2%)
0.005
   Overweight; n (%)
414 (6.1%)
115 (1.7%)
0.022
127 (1.9%)
251 (1.8%)
0.001
541 (4.0%)
366 (2.0%)
0.117
Cardiovascular Measures
Hypertension; n (%)
4,171 (61.2%)
4,326 (65.5%)
-0.005
3,474 (51.9%)
8,219 (58.7%)
-0.009
7,645 (56.6%)
12,545 (67.6%)
-0.228
Hyperlipidemia; n (%)
4,597 (67.5%)
4,422 (66.9%)
0.001
3,247 (48.5%)
7,278 (52.0%)
-0.005
7,844 (58.1%)
11,700 (63.1%)
-0.102
Coronary artery disease (MI, angina, Coronary atherosclerosis and 
other forms of chronic ischemic heart disease); n (%)
857 (12.6%)
1,130 (17.1%)
-0.012
813 (12.1%)
2,486 (17.8%)
-0.015
1,670 (12.4%)
3,616 (19.5%)
-0.195
    Old MI; n (%)
98 (1.4%)
157 (2.4%)
-0.007
49 (0.7%)
190 (1.4%)
-0.007
147 (1.1%)
347 (1.9%)
-0.066
    Acute MI; n (%)
39 (0.6%)
65 (1.0%)
-0.004
37 (0.6%)
150 (1.1%)
-0.005
076 (0.6%)
215 (1.2%)
-0.064
    ACS/unstable angina; n (%)
53 (0.8%)
90 (1.4%)
-0.006
78 (1.2%)
213 (1.5%)
-0.003
131 (1.0%)
303 (1.6%)
-0.053
    Stable angina; n (%)
223 (3.3%)
203 (3.1%)
0.001
145 (2.2%)
407 (2.9%)
-0.004
368 (2.7%)
610 (3.3%)
-0.035
    Coronary atherosclerosis and other CHD; n (%)
719 (10.6%)
1,010 (15.3%)
-0.013
710 (10.6%)
2,205 (15.8%)
-0.014
1,429 (10.6%)
3,215 (17.3%)
-0.194
    History of CABG or PTCA; n (%)
133 (2.0%)
222 (3.4%)
-0.009
60 (0.9%)
231 (1.7%)
-0.007
193 (1.4%)
453 (2.4%)
-0.073
Cerebrovascular disease (Stroke, TIA, Late effects); n (%)
281 (4.1%)
451 (6.8%)
-0.012
250 (3.7%)
948 (6.8%)
-0.014
531 (3.9%)
1,399 (7.5%)
-0.156
   Stroke (Ischemic or hemorrhagic); n (%)
134 (2.0%)
228 (3.5%)
-0.009
114 (1.7%)
516 (3.7%)
-0.012
248 (1.8%)
744 (4.0%)
-0.131
   TIA; n (%)
130 (1.9%)
230 (3.5%)
-0.010
129 (1.9%)
455 (3.3%)
-0.009
259 (1.9%)
685 (3.7%)
-0.109
   Late effects of cerebrovascular disease; n (%)
91 (1.3%)
128 (1.9%)
-0.005
57 (0.9%)
227 (1.6%)
-0.006
148 (1.1%)
355 (1.9%)
-0.066
Heart Failure; n (%)
224 (3.3%)
373 (5.6%)
-0.011
218 (3.3%)
680 (4.9%)
-0.008
442 (3.3%)
1,053 (5.7%)
-0.116
Peripheral Vascular Disease (PVD) or PVD Surgery; n (%)
480 (7.0%)
563 (8.5%)
-0.005
348 (5.2%)
1,077 (7.7%)
-0.010
828 (6.1%)
1,640 (8.8%)
-0.103
Atrial fibrillation and Other cardiac dysrhythmia; n (%)
836 (12.3%)
1,086 (16.4%)
-0.011
686 (10.2%)
2,302 (16.4%)
-0.017
1,522 (11.3%)
3,388 (18.3%)
-0.198
   Atrial fibrillation; n (%)
385 (5.6%)
582 (8.8%)
-0.012
294 (4.4%)
1,261 (9.0%)
-0.018
679 (5.0%)
1,843 (9.9%)
-0.187
   Other cardiac dysrhythmia; n (%)
689 (10.1%)
774 (11.7%)
-0.005
529 (7.9%)
1,617 (11.6%)
-0.012
1,218 (9.0%)
2,391 (12.9%)
-0.125
Diabetes Related Measures
Diabetes with or w/o complications; n (%)
1,348 (19.8%)
1,245 (18.8%)
0.002
1,035 (15.5%)
2,539 (18.1%)
-0.006
2,383 (17.6%)
3,784 (20.4%)
-0.071
   Diabetes mellitus without mention of complications; n (%)
1,266 (18.6%)
1,140 (17.3%)
0.003
944 (14.1%)
2,305 (16.5%)
-0.006
2,210 (16.4%)
3,445 (18.6%)
-0.058
   Diabetes with specified complications; n (%)
361 (5.3%)
402 (6.1%)
-0.003
230 (3.4%)
723 (5.2%)
-0.009
591 (4.4%)
1,125 (6.1%)
-0.076
   Diabetes with unspecified complications; n (%)
83 (1.2%)
66 (1.0%)
0.002
36 (0.5%)
101 (0.7%)
-0.003
119 (0.9%)
167 (0.9%)
0.000
Hypoglycemia; n (%)
67 (1.0%)
77 (1.2%)
-0.002
54 (0.8%)
153 (1.1%)
-0.003
121 (0.9%)
230 (1.2%)
-0.029
GI Conditions
Malabsorption disorders (Non-infective enteritis and colitis, other 
intestinal mal., operative-related disorders of the digestive 
system); n (%)
617 (9.1%)
947 (14.3%)
-0.015
667 (10.0%)
1,797 (12.8%)
-0.008
1,284 (9.5%)
2,744 (14.8%)
-0.163
   Non-infective enteritis and colitis; n (%)
388 (5.7%)
638 (9.7%)
-0.014
424 (6.3%)
1,200 (8.6%)
-0.008
812 (6.0%)
1,838 (9.9%)
-0.145
   Other intestinal malabsorption ; n (%)
39 (0.6%)
62 (0.9%)
-0.003
39 (0.6%)
134 (1.0%)
-0.004
078 (0.6%)
196 (1.1%)
-0.054
Marketscan
POOLED
Unmatched
Optum
Appendix B

   Intraoperative and postprocedural complications  and disorders 
of digestive system; n (%)
259 (3.8%)
369 (5.6%)
-0.008
275 (4.1%)
683 (4.9%)
-0.004
534 (4.0%)
1,052 (5.7%)
-0.079
Upper GI (Diseases of esophagus, stomach and duodenum); n (%)
2,152 (31.6%)
2,650 (40.1%)
-0.014
1,566 (23.4%)
4,379 (31.3%)
-0.015
3,718 (27.5%)
7,029 (37.9%)
-0.223
GI bleeding; n (%)
303 (4.4%)
345 (5.2%)
-0.004
284 (4.2%)
655 (4.7%)
-0.002
587 (4.3%)
1,000 (5.4%)
-0.051
Disorders of gallbladder, biliary tract and pancreas; n (%)
225 (3.3%)
217 (3.3%)
0.000
153 (2.3%)
467 (3.3%)
-0.006
378 (2.8%)
684 (3.7%)
-0.051
Rheumatic Conditions
Rheumatoid arthritis and other inflammatory polyarthropathies; n 
(%)
40 (0.6%)
44 (0.7%)
-0.001
18 (0.3%)
137 (1.0%)
-0.009
058 (0.4%)
181 (1.0%)
-0.072
Osteoarthrosis; n (%)
2,073 (30.4%)
2,519 (38.1%)
-0.013
1,684 (25.2%)
4,966 (35.5%)
-0.019
3,757 (27.8%)
7,485 (40.3%)
-0.266
Other rheumatic disorders (including gout); n (%)
4,099 (60.1%)
4,410 (66.8%)
-0.008
3,608 (53.9%)
8,399 (60.0%)
-0.008
7,707 (57.1%)
12,809 (69.0%)
-0.248
    Gout and other crystal arthropathies; n (%)
151 (2.2%)
135 (2.0%)
0.001
69 (1.0%)
222 (1.6%)
-0.005
220 (1.6%)
357 (1.9%)
-0.023
    Other rheumatic disorders; n (%)
4,052 (59.5%)
4,388 (66.4%)
-0.009
3,579 (53.5%)
8,336 (59.6%)
-0.008
7,631 (56.5%)
12,724 (68.6%)
-0.252
Neuro Conditions
Parkinson's disease; n (%)
26 (0.4%)
11 (0.2%)
0.004
18 (0.3%)
30 (0.2%)
0.002
044 (0.3%)
041 (0.2%)
0.020
Alzheimer and other Dementia Disease ; n (%)
366 (5.4%)
480 (7.3%)
-0.008
256 (3.8%)
911 (6.5%)
-0.012
622 (4.6%)
1,391 (7.5%)
-0.122
Seizure disorders (epilepsy); n (%)
53 (0.8%)
85 (1.3%)
-0.005
34 (0.5%)
143 (1.0%)
-0.006
087 (0.6%)
228 (1.2%)
-0.064
Delirium/Psychosis; n (%)
124 (1.8%)
162 (2.5%)
-0.005
112 (1.7%)
335 (2.4%)
-0.005
236 (1.7%)
497 (2.7%)
-0.068
Other Conditions
Hypothyroidism; n (%)
1,800 (26.4%)
1,941 (29.4%)
-0.006
1,277 (19.1%)
3,187 (22.8%)
-0.008
3,077 (22.8%)
5,128 (27.6%)
-0.111
Liver disease; n (%)
356 (5.2%)
227 (3.4%)
0.009
191 (2.9%)
481 (3.4%)
-0.003
547 (4.1%)
708 (3.8%)
0.015
Chronic kidney disease stages I-III; n (%)
705 (10.3%)
485 (7.3%)
0.010
322 (4.8%)
591 (4.2%)
0.003
1,027 (7.6%)
1,076 (5.8%)
0.072
Chronic kidney disease stages IV-V, ESRD; n (%)
201 (2.9%)
124 (1.9%)
0.006
102 (1.5%)
149 (1.1%)
0.004
303 (2.2%)
273 (1.5%)
0.052
Premature menopause; n (%)
7 (0.1%)
16 (0.2%)
-0.003
7 (0.1%)
28 (0.2%)
-0.003
014 (0.1%)
044 (0.2%)
-0.026
Oophorectomy; n (%)
5 (0.1%)
16 (0.2%)
-0.003
7 (0.1%)
11 (0.1%)
0.000
012 (0.1%)
027 (0.1%)
0.000
COPD; n (%)
691 (10.1%)
1,006 (15.2%)
-0.014
619 (9.2%)
1,926 (13.8%)
-0.014
1,310 (9.7%)
2,932 (15.8%)
-0.184
Asthma; n (%)
563 (8.3%)
639 (9.7%)
-0.005
516 (7.7%)
1,319 (9.4%)
-0.006
1,079 (8.0%)
1,958 (10.6%)
-0.090
Obstructive sleep apnea; n (%)
222 (3.3%)
314 (4.8%)
-0.007
173 (2.6%)
651 (4.7%)
-0.011
395 (2.9%)
965 (5.2%)
-0.117
Syncope; n (%)
249 (3.7%)
350 (5.3%)
-0.008
249 (3.7%)
734 (5.2%)
-0.007
498 (3.7%)
1,084 (5.8%)
-0.099
Falls; n (%)
539 (7.9%)
640 (9.7%)
-0.006
152 (2.3%)
607 (4.3%)
-0.011
691 (5.1%)
1,247 (6.7%)
-0.068
VTE; n (%)
86 (1.3%)
200 (3.0%)
-0.012
81 (1.2%)
390 (2.8%)
-0.011
167 (1.2%)
590 (3.2%)
-0.137
Gait abnormality; n (%)
558 (8.2%)
802 (12.1%)
-0.012
422 (6.3%)
1,352 (9.7%)
-0.012
980 (7.3%)
2,154 (11.6%)
-0.147
Osteopenia; n (%)
2,470 (36.2%)
2,435 (36.9%)
-0.001
1,890 (28.2%)
3,578 (25.6%)
0.005
4,360 (32.3%)
6,013 (32.4%)
-0.002
Hip and femur fractures; n (%)
165 (2.4%)
234 (3.5%)
-0.006
116 (1.7%)
508 (3.6%)
-0.012
281 (2.1%)
742 (4.0%)
-0.111
Vertebral fractures; n (%)
485 (7.1%)
872 (13.2%)
-0.019
559 (8.4%)
1,814 (13.0%)
-0.014
1,044 (7.7%)
2,686 (14.5%)
-0.218
Other Fractures ; n (%)
270 (4.0%)
327 (5.0%)
-0.005
220 (3.3%)
710 (5.1%)
-0.009
490 (3.6%)
1,037 (5.6%)
-0.096
Combined comorbidity score, 450 days
...mean (sd)
0.68 (1.77)
0.78 (1.84)
-0.055
0.34 (1.36)
0.66 (1.59)
-0.216
0.51 (1.58)
0.69 (1.67)
-0.111
...median [IQR]
0.00 [-1.00, 1.00]
0.00 [0.00, 2.00]
0.000
0.00 [-1.00, 1.00]
0.00 [0.00, 1.00]
0.000
0.00 (1.58)
0.00 (1.67)
0.000
Frailty Score: Empirical Version 365 days as Categories
...< 0.12908; n (%)
4,286 (62.9%)
2,288 (34.6%)
0.041
3,514 (52.5%)
4,520 (32.3%)
0.031
7,800 (57.8%)
6,808 (36.7%)
0.432
...0.12908 - 0.1631167; n (%)
1,318 (19.3%)
1,889 (28.6%)
-0.019
1,639 (24.5%)
4,003 (28.6%)
-0.008
2,957 (21.9%)
5,892 (31.8%)
-0.225
...>= 0.1631167; n (%)
1,211 (17.8%)
2,428 (36.8%)
-0.036
1,541 (23.0%)
5,474 (39.1%)
-0.029
2,752 (20.4%)
7,902 (42.6%)
-0.492
Medication Use
Use of Calcitonin (salmon); n (%)
1 (0.0%)
2 (0.0%)
0.000
275 (4.1%)
504 (3.6%)
0.003
276 (2.0%)
506 (2.7%)
-0.046
Use of oral corticosteroids; n (%)
1,595 (23.4%)
1,441 (21.8%)
0.003
1,652 (24.7%)
4,305 (30.8%)
-0.012
3,247 (24.0%)
5,746 (31.0%)
-0.157
Use of antidepressants; n (%)
1,511 (22.2%)
1,704 (25.8%)
-0.007
1,618 (24.2%)
4,513 (32.2%)
-0.015
3,129 (23.2%)
6,217 (33.5%)
-0.230
Use of anticonvulsants; n (%)
682 (10.0%)
761 (11.5%)
-0.005
702 (10.5%)
2,161 (15.4%)
-0.014
1,384 (10.2%)
2,922 (15.8%)
-0.167
Use of beta blocker OR calcium channel blocker; n (%)
1,947 (28.6%)
1,813 (27.4%)
0.002
2,048 (30.6%)
4,931 (35.2%)
-0.008
3,995 (29.6%)
6,744 (36.4%)
-0.145
Use of PPIs; n (%)
1,786 (26.2%)
1,883 (28.5%)
-0.004
1,983 (29.6%)
5,220 (37.3%)
-0.013
3,769 (27.9%)
7,103 (38.3%)
-0.222
Use of opioids; n (%)
1,927 (28.3%)
2,200 (33.3%)
-0.009
2,208 (33.0%)
6,037 (43.1%)
-0.016
4,135 (30.6%)
8,237 (44.4%)
-0.288
Use of antipsychotics; n (%)
105 (1.5%)
108 (1.6%)
-0.001
103 (1.5%)
302 (2.2%)
-0.005
208 (1.5%)
410 (2.2%)
-0.052
Use of anxiolytics/hypnotics; n (%)
526 (7.7%)
601 (9.1%)
-0.005
719 (10.7%)
1,682 (12.0%)
-0.004
1,245 (9.2%)
2,283 (12.3%)
-0.100
Use of dementia meds; n (%)
219 (3.2%)
232 (3.5%)
-0.002
192 (2.9%)
680 (4.9%)
-0.010
411 (3.0%)
912 (4.9%)
-0.098
Use of antiparkinsonian meds; n (%)
171 (2.5%)
211 (3.2%)
-0.004
168 (2.5%)
543 (3.9%)
-0.008
339 (2.5%)
754 (4.1%)
-0.090
Use of Benzodiazepine; n (%)
886 (13.0%)
686 (10.4%)
0.008
1,280 (19.1%)
3,137 (22.4%)
-0.007
2,166 (16.0%)
3,823 (20.6%)
-0.119
All antidiabetic medications; n (%)
762 (11.2%)
565 (8.6%)
0.008
645 (9.6%)
1,525 (10.9%)
-0.004
1,407 (10.4%)
2,090 (11.3%)
-0.029
ACEI/ARB; n (%)
2,651 (38.9%)
2,178 (33.0%)
0.010
2,539 (37.9%)
5,556 (39.7%)
-0.003
5,190 (38.4%)
7,734 (41.7%)
-0.067
Use of Anticoagulants; n (%)
297 (4.4%)
407 (6.2%)
-0.008
284 (4.2%)
1,223 (8.7%)
-0.018
581 (4.3%)
1,630 (8.8%)
-0.183
Use of Amiodarone; n (%)
41 (0.6%)
39 (0.6%)
0.000
48 (0.7%)
146 (1.0%)
-0.003
089 (0.7%)
185 (1.0%)
-0.033
Digoxin; n (%)
89 (1.3%)
112 (1.7%)
-0.003
104 (1.6%)
302 (2.2%)
-0.004
193 (1.4%)
414 (2.2%)
-0.060
Use of Diuretics; n (%)
1,978 (29.0%)
1,794 (27.2%)
0.003
2,103 (31.4%)
4,693 (33.5%)
-0.004
4,081 (30.2%)
6,487 (35.0%)
-0.103
Use of Aspirin; n (%)
37 (0.5%)
42 (0.6%)
-0.001
59 (0.9%)
158 (1.1%)
-0.002
096 (0.7%)
200 (1.1%)
-0.042
NSAIDs (NOT including aspirin); n (%)
1,374 (20.2%)
1,156 (17.5%)
0.006
1,314 (19.6%)
2,998 (21.4%)
-0.004
2,688 (19.9%)
4,154 (22.4%)
-0.061
Hormone replace therapy; n (%)
558 (8.2%)
598 (9.1%)
-0.003
840 (12.5%)
1,682 (12.0%)
0.001
1,398 (10.4%)
2,280 (12.3%)
-0.060
Other Pressors; n (%)
45 (0.7%)
38 (0.6%)
0.001
66 (1.0%)
134 (1.0%)
0.000
111 (0.8%)
172 (0.9%)
-0.011
Appendix B

Use of Statins ; n (%)
2,995 (43.9%)
2,448 (37.1%)
0.011
2,970 (44.4%)
6,633 (47.4%)
-0.004
5,965 (44.2%)
9,081 (48.9%)
-0.094
Prior bisphosphonate use; n (%)
1,625 (23.8%)
1,597 (24.2%)
-0.001
2,397 (35.8%)
5,368 (38.4%)
-0.004
4,022 (29.8%)
6,965 (37.5%)
-0.164
Healthcare Utilization Measures
Number of any prescribed drug
...mean (sd)
19.17 (16.44)
20.93 (19.56)
-0.097
19.38 (15.88)
25.07 (18.78)
-0.327
19.27 (16.16)
23.88 (19.01)
-0.261
...median [IQR]
15.00 [7.00, 27.00]
17.00 [4.50, 32.00]
-0.111
16.00 [8.00, 27.00]
22.00 [12.00, 35.00]
-0.345
15.50 (16.16)
20.56 (19.01)
-0.287
Number of office visits
...mean (sd)
11.51 (8.82)
14.63 (10.41)
-0.323
9.55 (7.33)
12.46 (8.75)
-0.361
10.54 (8.12)
13.09 (9.26)
-0.293
...median [IQR]
10.00 [6.00, 15.00]
12.00 [8.00, 19.00]
-0.207
8.00 [4.00, 13.00]
11.00 [6.00, 16.00]
-0.372
9.01 (8.12)
11.29 (9.26)
-0.262
Number of ED visits
...mean (sd)
0.36 (0.84)
0.53 (1.05)
-0.179
0.32 (0.82)
0.47 (1.03)
-0.161
0.34 (0.83)
0.49 (1.04)
-0.159
...median [IQR]
0.00 [0.00, 0.00]
0.00 [0.00, 1.00]
0.000
0.00 [0.00, 0.00]
0.00 [0.00, 1.00]
0.000
0.00 (0.83)
0.00 (1.04)
0.000
Number of Hospitalizations
...mean (sd)
0.15 (0.51)
0.25 (0.71)
-0.162
0.71 (2.75)
1.15 (3.69)
-0.135
0.43 (1.97)
0.89 (3.14)
-0.175
...median [IQR]
0.00 [0.00, 0.00]
0.00 [0.00, 0.00]
0.000
0.00 [0.00, 0.00]
0.00 [0.00, 0.00]
0.000
0.00 (1.97)
0.00 (3.14)
0.000
Recent hospitalization (-30 days to Index Rx date); n (%)
52 (0.8%)
40 (0.6%)
0.002
70 (1.0%)
88 (0.6%)
0.004
122 (0.9%)
128 (0.7%)
0.022
Old hospitalizations (-450 to -31 days); n (%)
591 (8.7%)
999 (15.1%)
-0.019
752 (11.2%)
2,464 (17.6%)
-0.017
1,343 (9.9%)
3,463 (18.7%)
-0.253
Number of Endocrinologist visits
...mean (sd)
0.17 (0.88)
0.40 (1.32)
-0.205
1.64 (2.66)
1.94 (3.23)
-0.101
0.90 (1.97)
1.50 (2.82)
-0.247
...median [IQR]
0.00 [0.00, 0.00]
0.00 [0.00, 0.00]
0.000
1.00 [0.00, 2.00]
1.00 [0.00, 3.00]
0.000
0.50 (1.97)
0.71 (2.82)
-0.086
Number of DXA test performed
...mean (sd)
0.70 (0.57)
0.76 (0.54)
-0.108
0.49 (0.53)
0.49 (0.54)
0.000
0.60 (0.55)
0.57 (0.54)
0.055
...median [IQR]
1.00 [0.00, 1.00]
1.00 [0.00, 1.00]
0.000
0.00 [0.00, 1.00]
0.00 [0.00, 1.00]
0.000
0.50 (0.55)
0.29 (0.54)
0.385
Number of days of hospitalization
...mean (sd)
1.33 (7.94)
2.10 (9.94)
-0.086
0.71 (2.75)
1.15 (3.69)
-0.135
1.02 (5.96)
1.42 (6.18)
-0.066
...median [IQR]
0.00 [0.00, 0.00]
0.00 [0.00, 0.00]
0.000
0.00 [0.00, 0.00]
0.00 [0.00, 0.00]
0.000
0.00 (5.96)
0.00 (6.18)
0.000
Occurrence of basic or comprehensive metabolic blood 
chemistry test; n (%)
5,101 (74.8%)
5,289 (80.1%)
-0.006
2,173 (32.5%)
6,380 (45.6%)
-0.021
7,274 (53.9%)
11,669 (62.9%)
-0.183
Number of HbA1C test ordered
...mean (sd)
0.67 (1.19)
0.50 (1.11)
0.148
0.21 (0.69)
0.23 (0.75)
-0.028
0.44 (0.97)
0.31 (0.87)
0.141
...median [IQR]
0.00 [0.00, 1.00]
0.00 [0.00, 0.00]
0.000
0.00 [0.00, 0.00]
0.00 [0.00, 0.00]
0.000
0.00 (0.97)
0.00 (0.87)
0.000
Occurrence of flexible Sigmoidoscopy or colonoscopy or CT 
virtual colonoscopy; n (%)
799 (11.7%)
882 (13.4%)
-0.005
848 (12.7%)
1,879 (13.4%)
-0.002
1,647 (12.2%)
2,761 (14.9%)
-0.079
Occurrence of Mammograms; n (%)
4,575 (67.1%)
4,379 (66.3%)
0.001
3,578 (53.5%)
6,460 (46.2%)
0.010
8,153 (60.4%)
10,839 (58.4%)
0.041
Occurrence of Pap smear; n (%)
1,595 (23.4%)
1,369 (20.7%)
0.006
1,557 (23.3%)
2,228 (15.9%)
0.017
3,152 (23.3%)
3,597 (19.4%)
0.095
Flu vaccine; n (%)
2,798 (41.1%)
3,017 (45.7%)
-0.007
1,593 (23.8%)
3,925 (28.0%)
-0.008
4,391 (32.5%)
6,942 (37.4%)
-0.103
Pneumococcal vaccine; n (%)
1,705 (25.0%)
827 (12.5%)
0.029
739 (11.0%)
1,691 (12.1%)
-0.003
2,444 (18.1%)
2,518 (13.6%)
0.123
Copay for pharmacy cost (charges in U.S. $)
...mean (sd)
36.83 (46.06)
31.00 (36.88)
0.140
23.13 (25.84)
20.45 (19.81)
0.116
30.04 (37.43)
23.49 (25.91)
0.203
...median [IQR]
24.21 [12.54, 43.97]
22.42 [10.81, 38.90]
0.043
17.50 [8.54, 30.00]
16.00 [8.28, 27.26]
0.065
20.89 (37.43)
17.85 (25.91)
0.094
Business Type
...Commercial; n (%)
1,324 (19.4%)
1,589 (24.1%)
-0.010
N/A
N/A
N/A
1,324 (19.4%)
1,589 (24.1%)
-0.010
...Medicare; n (%)
5,491 (80.6%)
5,016 (75.9%)
0.005
N/A
N/A
N/A
5,491 (80.6%)
5,016 (75.9%)
0.005
Insurance Plan Type
...Comprehensive; n (%)
N/A
N/A
N/A
2,485 (37.1%)
5,421 (38.7%)
-0.003
2,485 (37.1%)
5,421 (38.7%)
-0.003
...HMO; n (%)
N/A
N/A
N/A
698 (10.4%)
1,737 (12.4%)
-0.006
698 (10.4%)
1,737 (12.4%)
-0.006
...PPO; n (%)
N/A
N/A
N/A
3,108 (46.4%)
6,134 (43.8%)
0.004
3,108 (46.4%)
6,134 (43.8%)
0.004
...Others; n (%)
N/A
N/A
N/A
403 (6.0%)
705 (5.0%)
0.004
403 (6.0%)
705 (5.0%)
0.004
Optum (unmatched): https://bwh-dope.aetion.com/projects/details/1406/results/64560/result/2
Marketscan (unmatched): https://bwh-dope.aetion.com/projects/details/1407/results/64559/result/2
Appendix B

Variable
Raloxifene
Zoledronic Acid
St. Diff.
Raloxifene
Zoledronic Acid
St. Diff.
Raloxifene
Zoledronic Acid
St. Diff.
Number of patients
3,198 
3,198 
5,816 
5,816 
9,014 
9,014 
Age
...mean (sd)
73.50 (5.65)
73.62 (5.75)
-0.0211
74.24 (7.12)
74.29 (7.04)
-0.0071
73.98 (6.64)
74.05 (6.61)
-0.0106
...median [IQR]
74.00 [69.00, 78.00]
74.00 [69.00, 78.00]
0.0000
73.00 [68.00, 79.00]
73.00 [68.00, 79.00]
0.0000
73.35 (6.64)
73.35 (6.61)
0.0000
Age categories*
...< 70; n (%)
923 (28.9%)
942 (29.5%)
-0.0011
1,882 (32.4%)
1,891 (32.5%)
-0.0002
2,805 (31.1%)
2,833 (31.4%)
-0.0065
...70 - 74; n (%)
790 (24.7%)
792 (24.8%)
-0.0002
1,402 (24.1%)
1,396 (24.0%)
0.0002
2,192 (24.3%)
2,188 (24.3%)
0.0000
...>= 75; n (%)
1,485 (46.4%)
1,464 (45.8%)
0.0009
2,532 (43.5%)
2,529 (43.5%)
0.0000
4,017 (44.6%)
3,993 (44.3%)
0.0060
Region*
...Northeast; n (%)
277 (8.7%)
300 (9.4%)
-0.0023
1,045 (18.0%)
1,029 (17.7%)
0.0007
1,322 (14.7%)
1,329 (14.7%)
0.0000
...South; n (%)
1,464 (45.8%)
1,511 (47.2%)
-0.0021
1,926 (33.1%)
1,966 (33.8%)
-0.0012
3,390 (37.6%)
3,477 (38.6%)
-0.0206
...Midwest; n (%)
457 (14.3%)
426 (13.3%)
0.0027
1,975 (34.0%)
1,953 (33.6%)
0.0007
2,432 (27.0%)
2,379 (26.4%)
0.0136
...West; n (%)
1,000 (31.3%)
961 (30.1%)
0.0022
870 (15.0%)
868 (14.9%)
0.0003
1,870 (20.7%)
1,829 (20.3%)
0.0099
Calendar Time*
...Aug 2007 - Aug 2010; n (%)
1,153 (36.1%)
1,196 (37.4%)
-0.0021
1,797 (30.9%)
1,812 (31.2%)
-0.0005
2,950 (32.7%)
3,008 (33.4%)
-0.0149
...Aug 2010 - Aug 2013; n (%)
1,311 (41.0%)
1,285 (40.2%)
0.0013
2,047 (35.2%)
2,067 (35.5%)
-0.0005
3,358 (37.3%)
3,352 (37.2%)
0.0021
...Aug 2013 - Aug 2016; n (%)
295 (9.2%)
275 (8.6%)
0.0020
1,451 (24.9%)
1,460 (25.1%)
-0.0004
1,746 (19.4%)
1,735 (19.2%)
0.0051
...Aug 2016 - Mar 2020; n (%)
439 (13.7%)
442 (13.8%)
-0.0003
521 (9.0%)
477 (8.2%)
0.0027
960 (10.7%)
919 (10.2%)
0.0163
Metropolitan Statistical Area*
...Urban; n (%)
N/A
N/A
N/A
4,395 (75.6%)
4,392 (75.5%)
0.0001
4,521 (75.6%)
4,515 (75.5%)
0.0001
...Rural; n (%)
N/A
N/A
N/A
92 (1.6%)
98 (1.7%)
-0.0008
93 (1.6%)
95 (1.6%)
0.0000
...Unknown/Missing; n (%)
N/A
N/A
N/A
1,329 (22.9%)
1,326 (22.8%)
0.0002
1,369 (22.9%)
1,373 (22.9%)
0.0000
General Health Related Measures
Smoking; n (%)*
246 (7.7%)
267 (8.3%)
-0.0021
247 (4.2%)
267 (4.6%)
-0.0019
493 (5.5%)
534 (5.9%)
-0.0173
Alcohol/Drug abuse or dependence ; n (%)
11 (0.3%)
8 (0.3%)
0.0000
5 (0.1%)
5 (0.1%)
0.0000
016 (0.2%)
013 (0.1%)
0.0258
Obesity or Overweight; n (%)*
252 (7.9%)
233 (7.3%)
0.0022
267 (4.6%)
262 (4.5%)
0.0005
519 (5.8%)
495 (5.5%)
0.0130
   Obesity; n (%)
158 (4.9%)
153 (4.8%)
0.0005
161 (2.8%)
178 (3.1%)
-0.0017
319 (3.5%)
331 (3.7%)
-0.0107
   Overweight; n (%)
108 (3.4%)
96 (3.0%)
0.0022
123 (2.1%)
100 (1.7%)
0.0029
231 (2.6%)
196 (2.2%)
0.0261
Cardiovascular Measures
Hypertension; n (%)*
2,020 (63.2%)
2,032 (63.5%)
-0.0004
3,125 (53.7%)
3,123 (53.7%)
0.0000
5,145 (57.1%)
5,155 (57.2%)
-0.0020
Hyperlipidemia; n (%)*
2,177 (68.1%)
2,218 (69.4%)
-0.0016
2,903 (49.9%)
2,946 (50.7%)
-0.0011
5,080 (56.4%)
5,164 (57.3%)
-0.0182
Coronary artery disease (MI, angina, Coronary atherosclerosis and 
other forms of chronic ischemic heart disease); n (%)*
490 (15.3%)
477 (14.9%)
0.0010
763 (13.1%)
769 (13.2%)
-0.0003
1,253 (13.9%)
1,246 (13.8%)
0.0029
    Old MI; n (%)
56 (1.8%)
69 (2.2%)
-0.0028
49 (0.8%)
58 (1.0%)
-0.0021
105 (1.2%)
127 (1.4%)
-0.0177
    Acute MI; n (%)
22 (0.7%)
28 (0.9%)
-0.0022
32 (0.6%)
37 (0.6%)
0.0000
054 (0.6%)
065 (0.7%)
-0.0124
    ACS/unstable angina; n (%)
37 (1.2%)
33 (1.0%)
0.0019
70 (1.2%)
64 (1.1%)
0.0009
107 (1.2%)
097 (1.1%)
0.0094
    Stable angina; n (%)
107 (3.3%)
96 (3.0%)
0.0017
134 (2.3%)
140 (2.4%)
-0.0007
241 (2.7%)
236 (2.6%)
0.0062
    Coronary atherosclerosis and other CHD; n (%)
427 (13.4%)
416 (13.0%)
0.0011
671 (11.5%)
686 (11.8%)
-0.0009
1,098 (12.2%)
1,102 (12.2%)
0.0000
    History of CABG or PTCA; n (%)
75 (2.3%)
81 (2.5%)
-0.0013
57 (1.0%)
70 (1.2%)
-0.0019
132 (1.5%)
151 (1.7%)
-0.0159
Cerebrovascular disease (Stroke, TIA, Late effects); n (%)*
162 (5.1%)
170 (5.3%)
-0.0009
241 (4.1%)
241 (4.1%)
0.0000
403 (4.5%)
411 (4.6%)
-0.0048
   Stroke (Ischemic or hemorrhagic); n (%)
79 (2.5%)
96 (3.0%)
-0.0030
113 (1.9%)
129 (2.2%)
-0.0021
192 (2.1%)
225 (2.5%)
-0.0267
   TIA; n (%)
72 (2.3%)
82 (2.6%)
-0.0019
125 (2.1%)
119 (2.0%)
0.0007
197 (2.2%)
201 (2.2%)
0.0000
   Late effects of cerebrovascular disease; n (%)
56 (1.8%)
45 (1.4%)
0.0032
53 (0.9%)
49 (0.8%)
0.0011
109 (1.2%)
094 (1.0%)
0.0192
Heart Failure; n (%)*
143 (4.5%)
141 (4.4%)
0.0005
205 (3.5%)
196 (3.4%)
0.0005
348 (3.9%)
337 (3.7%)
0.0105
Peripheral Vascular Disease (PVD) or PVD Surgery; n (%)*
243 (7.6%)
227 (7.1%)
0.0018
333 (5.7%)
315 (5.4%)
0.0013
576 (6.4%)
542 (6.0%)
0.0166
Atrial fibrillation and Other cardiac dysrhythmia; n (%)*
446 (13.9%)
445 (13.9%)
0.0000
657 (11.3%)
671 (11.5%)
-0.0006
1,103 (12.2%)
1,116 (12.4%)
-0.0061
   Atrial fibrillation; n (%)
207 (6.5%)
235 (7.3%)
-0.0030
287 (4.9%)
326 (5.6%)
-0.0031
494 (5.5%)
561 (6.2%)
-0.0298
   Other cardiac dysrhythmia; n (%)
346 (10.8%)
334 (10.4%)
0.0012
504 (8.7%)
494 (8.5%)
0.0007
850 (9.4%)
828 (9.2%)
0.0069
Diabetes Related Measures
Diabetes with or w/o complications; n (%)*
614 (19.2%)
635 (19.9%)
-0.0016
937 (16.1%)
916 (15.7%)
0.0010
1,551 (17.2%)
1,551 (17.2%)
0.0000
   Diabetes mellitus without mention of complications; n (%)
568 (17.8%)
586 (18.3%)
-0.0012
854 (14.7%)
849 (14.6%)
0.0003
1,422 (15.8%)
1,435 (15.9%)
-0.0027
   Diabetes with specified complications; n (%)
180 (5.6%)
192 (6.0%)
-0.0017
215 (3.7%)
219 (3.8%)
-0.0005
395 (4.4%)
411 (4.6%)
-0.0096
   Diabetes with unspecified complications; n (%)
35 (1.1%)
34 (1.1%)
0.0000
32 (0.6%)
36 (0.6%)
0.0000
067 (0.7%)
070 (0.8%)
-0.0116
Hypoglycemia; n (%)
42 (1.3%)
40 (1.3%)
0.0000
52 (0.9%)
44 (0.8%)
0.0011
094 (1.0%)
084 (0.9%)
0.0103
GI Conditions
Malabsorption disorders (Non-infective enteritis and colitis, other 
intestinal mal., operative-related disorders of the digestive 
system); n (%)*
363 (11.4%)
361 (11.3%)
0.0003
605 (10.4%)
625 (10.7%)
-0.0009
968 (10.7%)
986 (10.9%)
-0.0064
   Non-infective enteritis and colitis; n (%)
230 (7.2%)
237 (7.4%)
-0.0007
390 (6.7%)
387 (6.7%)
0.0000
620 (6.9%)
624 (6.9%)
0.0000
PS-matched
Optum
Marketscan
POOLED
Appendix B

   Other intestinal malabsorption ; n (%)
16 (0.5%)
21 (0.7%)
-0.0026
37 (0.6%)
50 (0.9%)
-0.0035
053 (0.6%)
071 (0.8%)
-0.0240
   Intraoperative and postprocedural complications  and disorders 
of digestive system; n (%)
159 (5.0%)
146 (4.6%)
0.0018
248 (4.3%)
263 (4.5%)
-0.0010
407 (4.5%)
409 (4.5%)
0.0000
Upper GI (Diseases of esophagus, stomach and duodenum); n 
(%)*
1,141 (35.7%)
1,138 (35.6%)
0.0002
1,466 (25.2%)
1,430 (24.6%)
0.0012
2,607 (28.9%)
2,568 (28.5%)
0.0088
GI bleeding; n (%)*
161 (5.0%)
160 (5.0%)
0.0000
252 (4.3%)
269 (4.6%)
-0.0014
413 (4.6%)
429 (4.8%)
-0.0095
Disorders of gallbladder, biliary tract and pancreas; n (%)*
87 (2.7%)
88 (2.8%)
-0.0006
145 (2.5%)
148 (2.5%)
0.0000
232 (2.6%)
236 (2.6%)
0.0000
Rheumatic Conditions
Rheumatoid arthritis and other inflammatory polyarthropathies; n 
(%)
16 (0.5%)
28 (0.9%)
-0.0048
18 (0.3%)
48 (0.8%)
-0.0067
034 (0.4%)
076 (0.8%)
-0.0518
Osteoarthrosis; n (%)*
1,087 (34.0%)
1,111 (34.7%)
-0.0012
1,603 (27.6%)
1,636 (28.1%)
-0.0009
2,690 (29.8%)
2,747 (30.5%)
-0.0153
Other rheumatic disorders (including gout); n (%)*
2,019 (63.1%)
2,045 (63.9%)
-0.0010
3,198 (55.0%)
3,248 (55.8%)
-0.0011
5,217 (57.9%)
5,293 (58.7%)
-0.0162
    Gout and other crystal arthropathies; n (%)
70 (2.2%)
55 (1.7%)
0.0036
65 (1.1%)
62 (1.1%)
0.0000
135 (1.5%)
117 (1.3%)
0.0170
    Other rheumatic disorders; n (%)
1,999 (62.5%)
2,033 (63.6%)
-0.0014
3,170 (54.5%)
3,225 (55.5%)
-0.0014
5,169 (57.3%)
5,258 (58.3%)
-0.0202
Neuro Conditions
Parkinson's disease; n (%)
8 (0.3%)
6 (0.2%)
0.0020
18 (0.3%)
10 (0.2%)
0.0020
026 (0.3%)
016 (0.2%)
0.0200
Alzheimer and other Dementia Disease ; n (%)*
193 (6.0%)
189 (5.9%)
0.0004
253 (4.4%)
257 (4.4%)
0.0000
446 (4.9%)
446 (4.9%)
0.0000
Seizure disorders (epilepsy); n (%)
29 (0.9%)
36 (1.1%)
-0.0020
31 (0.5%)
41 (0.7%)
-0.0026
060 (0.7%)
077 (0.9%)
-0.0225
Delirium/Psychosis; n (%)
64 (2.0%)
59 (1.8%)
0.0015
109 (1.9%)
84 (1.4%)
0.0039
173 (1.9%)
143 (1.6%)
0.0229
Other Conditions
Hypothyroidism; n (%)*
900 (28.1%)
933 (29.2%)
-0.0021
1,179 (20.3%)
1,164 (20.0%)
0.0007
2,079 (23.1%)
2,097 (23.3%)
-0.0047
Liver disease; n (%)*
109 (3.4%)
121 (3.8%)
-0.0021
175 (3.0%)
164 (2.8%)
0.0012
284 (3.2%)
285 (3.2%)
0.0000
Chronic kidney disease stages I-III; n (%)*
284 (8.9%)
276 (8.6%)
0.0010
284 (4.9%)
272 (4.7%)
0.0009
568 (6.3%)
548 (6.1%)
0.0083
Chronic kidney disease stages IV-V, ESRD; n (%)
103 (3.2%)
70 (2.2%)
0.0061
89 (1.5%)
55 (0.9%)
0.0055
192 (2.1%)
125 (1.4%)
0.0534
Premature menopause; n (%)
3 (0.1%)
7 (0.2%)
-0.0026
5 (0.1%)
10 (0.2%)
-0.0026
008 (0.1%)
017 (0.2%)
-0.0258
Oophorectomy; n (%)
3 (0.1%)
5 (0.2%)
-0.0026
7 (0.1%)
3 (0.1%)
0.0000
010 (0.1%)
008 (0.1%)
0.0000
COPD; n (%)*
411 (12.9%)
401 (12.5%)
0.0011
584 (10.0%)
594 (10.2%)
-0.0006
995 (11.0%)
995 (11.0%)
0.0000
Asthma; n (%)*
294 (9.2%)
300 (9.4%)
-0.0007
461 (7.9%)
490 (8.4%)
-0.0018
755 (8.4%)
790 (8.8%)
-0.0143
Obstructive sleep apnea; n (%)*
123 (3.8%)
125 (3.9%)
-0.0005
171 (2.9%)
152 (2.6%)
0.0018
294 (3.3%)
277 (3.1%)
0.0114
Syncope; n (%)*
131 (4.1%)
139 (4.3%)
-0.0010
236 (4.1%)
236 (4.1%)
0.0000
367 (4.1%)
375 (4.2%)
-0.0050
Falls; n (%)*
266 (8.3%)
272 (8.5%)
-0.0007
146 (2.5%)
157 (2.7%)
-0.0012
412 (4.6%)
429 (4.8%)
-0.0095
VTE; n (%)
47 (1.5%)
72 (2.3%)
-0.0058
78 (1.3%)
119 (2.0%)
-0.0054
125 (1.4%)
191 (2.1%)
-0.0534
Gait abnormality; n (%)*
282 (8.8%)
305 (9.5%)
-0.0023
405 (7.0%)
373 (6.4%)
0.0023
687 (7.6%)
678 (7.5%)
0.0038
Osteopenia; n (%)*
1,200 (37.5%)
1,203 (37.6%)
-0.0002
1,585 (27.3%)
1,626 (28.0%)
-0.0013
2,785 (30.9%)
2,829 (31.4%)
-0.0108
Hip and femur fractures; n (%)*
86 (2.7%)
98 (3.1%)
-0.0023
113 (1.9%)
122 (2.1%)
-0.0014
199 (2.2%)
220 (2.4%)
-0.0133
Vertebral fractures; n (%)*
298 (9.3%)
304 (9.5%)
-0.0007
543 (9.3%)
527 (9.1%)
0.0007
841 (9.3%)
831 (9.2%)
0.0035
Other Fractures ; n (%)*
141 (4.4%)
142 (4.4%)
0.0000
206 (3.5%)
206 (3.5%)
0.0000
347 (3.8%)
348 (3.9%)
-0.0052
Combined comorbidity score, 450 days*
...mean (sd)
0.70 (1.83)
0.68 (1.82)
0.0110
0.40 (1.40)
0.40 (1.37)
0.0000
0.51 (1.57)
0.50 (1.54)
0.0064
...median [IQR]
0.00 [-1.00, 1.00]
0.00 [-1.00, 1.00]
0.0000
0.00 [-1.00, 1.00]
0.00 [0.00, 1.00]
0.0000
0.00 (1.57)
0.00 (1.54)
0.0000
Frailty Score: Empirical Version 365 days as Categories*
...< 0.12908; n (%)
1,492 (46.7%)
1,502 (47.0%)
-0.0004
2,738 (47.1%)
2,740 (47.1%)
0.0000
4,230 (46.9%)
4,242 (47.1%)
-0.0040
...0.12908 - 0.1631167; n (%)
866 (27.1%)
846 (26.5%)
0.0012
1,570 (27.0%)
1,563 (26.9%)
0.0002
2,436 (27.0%)
2,409 (26.7%)
0.0068
...>= 0.1631167; n (%)
840 (26.3%)
850 (26.6%)
-0.0006
1,508 (25.9%)
1,513 (26.0%)
-0.0002
2,348 (26.0%)
2,363 (26.2%)
-0.0046
Medication Use
Use of Calcitonin (salmon); n (%)
1 (0.0%)
0 (0.0%)
0.0000
243 (4.2%)
213 (3.7%)
0.0025
244 (2.7%)
213 (2.4%)
0.0190
Use of oral corticosteroids; n (%)*
779 (24.4%)
770 (24.1%)
0.0006
1,542 (26.5%)
1,540 (26.5%)
0.0000
2,321 (25.7%)
2,310 (25.6%)
0.0023
Use of antidepressants; n (%)*
836 (26.1%)
821 (25.7%)
0.0008
1,522 (26.2%)
1,542 (26.5%)
-0.0006
2,358 (26.2%)
2,363 (26.2%)
0.0000
Use of anticonvulsants; n (%)*
353 (11.0%)
387 (12.1%)
-0.0032
669 (11.5%)
689 (11.8%)
-0.0009
1,022 (11.3%)
1,076 (11.9%)
-0.0187
Use of beta blocker OR calcium channel blocker; n (%)*
1,013 (31.7%)
1,009 (31.6%)
0.0002
1,855 (31.9%)
1,884 (32.4%)
-0.0009
2,868 (31.8%)
2,893 (32.1%)
-0.0064
Use of PPIs; n (%)*
968 (30.3%)
962 (30.1%)
0.0004
1,845 (31.7%)
1,863 (32.0%)
-0.0005
2,813 (31.2%)
2,825 (31.3%)
-0.0022
Use of opioids; n (%)*
1,100 (34.4%)
1,111 (34.7%)
-0.0005
2,080 (35.8%)
2,074 (35.7%)
0.0002
3,180 (35.3%)
3,185 (35.3%)
0.0000
Use of antipsychotics; n (%)*
58 (1.8%)
56 (1.8%)
0.0000
97 (1.7%)
86 (1.5%)
0.0016
155 (1.7%)
142 (1.6%)
0.0079
Use of anxiolytics/hypnotics; n (%)*
301 (9.4%)
293 (9.2%)
0.0007
656 (11.3%)
660 (11.3%)
0.0000
957 (10.6%)
953 (10.6%)
0.0000
Use of dementia meds; n (%)*
109 (3.4%)
117 (3.7%)
-0.0016
188 (3.2%)
200 (3.4%)
-0.0011
297 (3.3%)
317 (3.5%)
-0.0110
Use of antiparkinsonian meds; n (%)*
103 (3.2%)
105 (3.3%)
-0.0006
157 (2.7%)
156 (2.7%)
0.0000
260 (2.9%)
261 (2.9%)
0.0000
Use of Benzodiazepine; n (%)*
403 (12.6%)
402 (12.6%)
0.0000
1,192 (20.5%)
1,196 (20.6%)
-0.0002
1,595 (17.7%)
1,598 (17.7%)
0.0000
All antidiabetic medications; n (%)*
341 (10.7%)
351 (11.0%)
-0.0009
589 (10.1%)
583 (10.0%)
0.0003
930 (10.3%)
934 (10.4%)
-0.0033
ACEI/ARB; n (%)*
1,218 (38.1%)
1,241 (38.8%)
-0.0011
2,250 (38.7%)
2,256 (38.8%)
-0.0002
3,468 (38.5%)
3,497 (38.8%)
-0.0062
Use of Anticoagulants; n (%)*
176 (5.5%)
183 (5.7%)
-0.0008
282 (4.8%)
315 (5.4%)
-0.0027
458 (5.1%)
498 (5.5%)
-0.0179
Use of Amiodarone; n (%)
25 (0.8%)
19 (0.6%)
0.0024
48 (0.8%)
37 (0.6%)
0.0024
073 (0.8%)
056 (0.6%)
0.0240
Digoxin; n (%)
52 (1.6%)
58 (1.8%)
-0.0015
97 (1.7%)
92 (1.6%)
0.0008
149 (1.7%)
150 (1.7%)
0.0000
Use of Diuretics; n (%)*
1,021 (31.9%)
1,041 (32.6%)
-0.0012
1,865 (32.1%)
1,857 (31.9%)
0.0004
2,886 (32.0%)
2,898 (32.1%)
-0.0021
Use of Aspirin; n (%)
25 (0.8%)
21 (0.7%)
0.0012
55 (0.9%)
56 (1.0%)
-0.0010
080 (0.9%)
077 (0.9%)
0.0000
Appendix B

NSAIDs (NOT including aspirin); n (%)
651 (20.4%)
643 (20.1%)
0.0007
1,198 (20.6%)
1,155 (19.9%)
0.0016
1,849 (20.5%)
1,798 (19.9%)
0.0149
Hormone replace therapy; n (%)*
315 (9.8%)
318 (9.9%)
-0.0003
743 (12.8%)
751 (12.9%)
-0.0003
1,058 (11.7%)
1,069 (11.9%)
-0.0062
Other Pressors; n (%)
23 (0.7%)
16 (0.5%)
0.0026
64 (1.1%)
66 (1.1%)
0.0000
087 (1.0%)
082 (0.9%)
0.0103
Use of Statins ; n (%)*
1,427 (44.6%)
1,443 (45.1%)
-0.0007
2,677 (46.0%)
2,656 (45.7%)
0.0004
4,104 (45.5%)
4,099 (45.5%)
0.0000
Prior bisphosphonate use; n (%)
746 (23.3%)
847 (26.5%)
-0.0064
2,079 (35.7%)
2,246 (38.6%)
-0.0048
2,825 (31.3%)
3,093 (34.3%)
-0.0639
Healthcare Utilization Measures
Number of any prescribed drug*
...mean (sd)
22.08 (18.32)
21.98 (16.47)
0.0057
20.71 (16.23)
20.85 (15.42)
-0.0088
21.20 (17.00)
21.25 (15.80)
-0.0030
...median [IQR]
18.00 [8.00, 31.00]
18.00 [10.00, 30.00]
0.0000
17.00 [9.00, 28.00]
18.00 [10.00, 28.00]
-0.0632
17.35 (17.00)
18.00 (15.80)
-0.0396
Number of office visits*
...mean (sd)
12.76 (9.40)
12.86 (8.99)
-0.0109
10.14 (7.52)
10.11 (7.03)
0.0041
11.07 (8.24)
11.09 (7.78)
-0.0025
...median [IQR]
10.00 [6.00, 17.00]
11.00 [7.00, 16.25]
-0.1087
9.00 [5.00, 14.00]
9.00 [5.00, 13.00]
0.0000
9.35 (8.24)
9.71 (7.78)
-0.0449
Number of ED visits*
...mean (sd)
0.42 (0.91)
0.42 (0.93)
0.0000
0.34 (0.85)
0.34 (0.89)
0.0000
0.37 (0.87)
0.37 (0.90)
0.0000
...median [IQR]
0.00 [0.00, 1.00]
0.00 [0.00, 1.00]
0.0000
0.00 [0.00, 0.00]
0.00 [0.00, 0.00]
0.0000
0.00 (0.87)
0.00 (0.90)
0.0000
Number of Hospitalizations*
...mean (sd)
0.16 (0.53)
0.18 (0.61)
-0.0350
0.78 (2.88)
0.77 (2.89)
0.0035
0.56 (2.33)
0.56 (2.35)
0.0000
...median [IQR]
0.00 [0.00, 0.00]
0.00 [0.00, 0.00]
0.0000
0.00 [0.00, 0.00]
0.00 [0.00, 0.00]
0.0000
0.00 (2.33)
0.00 (2.35)
0.0000
Recent hospitalization (-30 days to Index Rx date); n (%)
18 (0.6%)
20 (0.6%)
0.0000
54 (0.9%)
53 (0.9%)
0.0000
072 (0.8%)
073 (0.8%)
0.0000
Old hospitalizations (-450 to -31 days); n (%)
326 (10.2%)
347 (10.9%)
-0.0022
721 (12.4%)
732 (12.6%)
-0.0006
1,047 (11.6%)
1,079 (12.0%)
-0.0124
Number of Endocrinologist visits*
...mean (sd)
0.23 (1.14)
0.26 (1.02)
-0.0277
1.72 (2.75)
1.71 (3.02)
0.0035
1.19 (2.31)
1.20 (2.50)
-0.0042
...median [IQR]
0.00 [0.00, 0.00]
0.00 [0.00, 0.00]
0.0000
1.00 [0.00, 2.00]
1.00 [0.00, 2.00]
0.0000
0.65 (2.31)
0.65 (2.50)
0.0000
Number of DXA test performed*
...mean (sd)
0.73 (0.59)
0.73 (0.53)
0.0000
0.49 (0.53)
0.50 (0.54)
-0.0187
0.58 (0.55)
0.58 (0.54)
0.0000
...median [IQR]
1.00 [0.00, 1.00]
1.00 [0.00, 1.00]
0.0000
0.00 [0.00, 1.00]
0.00 [0.00, 1.00]
0.0000
0.35 (0.55)
0.35 (0.54)
0.0000
Number of days of hospitalization*
...mean (sd)
1.35 (6.46)
1.58 (8.51)
-0.0304
0.78 (2.88)
0.77 (2.89)
0.0035
0.98 (4.49)
1.06 (5.57)
-0.0158
...median [IQR]
0.00 [0.00, 0.00]
0.00 [0.00, 0.00]
0.0000
0.00 [0.00, 0.00]
0.00 [0.00, 0.00]
0.0000
0.00 (4.49)
0.00 (5.57)
0.0000
Occurrence of basic or comprehensive metabolic blood 
chemistry test; n (%)*
2,462 (77.0%)
2,446 (76.5%)
0.0006
2,084 (35.8%)
2,096 (36.0%)
-0.0003
4,546 (50.4%)
4,542 (50.4%)
0.0000
Number of HbA1C test ordered*
...mean (sd)
0.55 (1.10)
0.57 (1.15)
-0.0178
0.22 (0.71)
0.21 (0.71)
0.0141
0.34 (0.87)
0.34 (0.89)
0.0000
...median [IQR]
0.00 [0.00, 1.00]
0.00 [0.00, 1.00]
0.0000
0.00 [0.00, 0.00]
0.00 [0.00, 0.00]
0.0000
0.00 (0.87)
0.00 (0.89)
0.0000
Occurrence of flexible Sigmoidoscopy or colonoscopy or CT 
virtual colonoscopy; n (%)*
395 (12.4%)
401 (12.5%)
-0.0003
752 (12.9%)
763 (13.1%)
-0.0006
1,147 (12.7%)
1,164 (12.9%)
-0.0060
Occurrence of Mammograms; n (%)*
2,172 (67.9%)
2,175 (68.0%)
-0.0001
2,980 (51.2%)
3,031 (52.1%)
-0.0013
5,152 (57.2%)
5,206 (57.8%)
-0.0121
Occurrence of Pap smear; n (%)*
761 (23.8%)
771 (24.1%)
-0.0006
1,213 (20.9%)
1,262 (21.7%)
-0.0017
1,974 (21.9%)
2,033 (22.6%)
-0.0168
Flu vaccine; n (%)*
1,368 (42.8%)
1,331 (41.6%)
0.0019
1,458 (25.1%)
1,429 (24.6%)
0.0010
2,826 (31.4%)
2,760 (30.6%)
0.0173
Pneumococcal vaccine; n (%)*
536 (16.8%)
505 (15.8%)
0.0025
684 (11.8%)
672 (11.6%)
0.0006
1,220 (13.5%)
1,177 (13.1%)
0.0118
Copay for pharmacy cost (charges in U.S. $)*
...mean (sd)
32.98 (33.52)
32.63 (41.44)
0.0093
21.73 (21.64)
21.97 (23.47)
-0.0106
25.72 (26.47)
25.75 (31.06)
-0.0010
...median [IQR]
24.20 [13.60, 40.24]
23.21 [10.71, 40.75]
0.0263
16.93 [8.43, 28.46]
16.47 [8.00, 29.05]
0.0204
19.51 (26.47)
18.86 (31.06)
0.0225
Business Type*
...Commercial; n (%)
754 (23.6%)
785 (24.5%)
-0.002
N/A
N/A
N/A
754 (23.6%)
785 (24.5%)
-0.002
...Medicare; n (%)
2,444 (76.4%)
2,413 (75.5%)
0.001
N/A
N/A
N/A
2,444 (76.4%)
2,413 (75.5%)
0.001
Insurance Plan Type*
...Comprehensive; n (%)
N/A
N/A
N/A
2,179 (37.5%)
2,153 (37.0%)
0.001
2,179 (37.5%)
2,153 (37.0%)
0.001
...HMO; n (%)
N/A
N/A
N/A
636 (10.9%)
629 (10.8%)
0.000
636 (10.9%)
629 (10.8%)
0.000
...PPO; n (%)
N/A
N/A
N/A
2,686 (46.2%)
2,711 (46.6%)
-0.001
2,686 (46.2%)
2,711 (46.6%)
-0.001
...Others; n (%)
N/A
N/A
N/A
315 (5.4%)
323 (5.6%)
-0.001
315 (5.4%)
323 (5.6%)
-0.001
*Included in the 1:1 PS matching model
Optum (PS matched): https://bwh-dope.aetion.com/projects/details/1406/results/63149/result/44
Marketscan (PS matched): https://bwh-dope.aetion.com/projects/details/1407/results/63153/result/44
Appendix B