A LARGE Austrian nationwide analysis has revealed that osteoporosis often goes unrecorded in hospital records after a fragility fracture, with hip fractures far more likely than wrist or arm fractures to be linked to a formal osteoporosis diagnosis, particularly in men.
Researchers conducted a nationwide retrospective analysis of Austrian inpatient insurance claims data from 2003 to 2014, including 1,705,684 hospitalised patients aged 50 to 79 years. Comorbidity network analysis characterised sex- and age-specific diagnoses co-occurring with osteoporosis, coded as with (M80) or without (M81) pathological fracture. Fracture-centred networks were also constructed for major fracture types to assess whether osteoporosis was systematically coded during fracture-related hospitalisations, and sex-specific odds ratios compared comorbidity associations between males and females across three age groups: 50-59, 60-69, and 70-79 years.
Across all age groups, females showed substantially broader osteoporosis-associated comorbidity networks than males, with linked diagnoses increasing from 142 to 245 to 330 in females and 76 to 137 to 164 in males across the three age groups. Fractures were embedded within multimorbidity networks rather than forming isolated links with osteoporosis. Hip fractures showed the strongest co-occurrence with osteoporosis, particularly in females aged 60 and older, whereas upper limb fractures showed no osteoporosis diagnoses among significant co-diagnoses in any age group, despite being considered early fragility fractures. In patients aged 50 to 69, male fracture networks showed stronger co-occurrence with trauma- and alcohol-related diagnoses, while older groups in both sexes increasingly showed neurodegenerative, cardiovascular, respiratory, and renal comorbidities. Co-occurrence between osteoporosis without and with pathological fracture was consistently stronger in males than females across all ages (eg, odds ratio 63.74 vs 18.53 at ages 50-59).
These findings have suggested that osteoporosis is not systematically coded across all fracture types in routine hospital data, with upper limb fractures rarely recorded alongside osteoporosis diagnoses despite being recognised as potential fragility fractures. As this was a retrospective analysis based on coded hospital data, causality cannot be established. The authors have suggested these patterns point to under-recognition of osteoporosis at the time of fracture, particularly among younger patients and men.
Reference
Behanova M et al. Sex-and age-specific comorbidity networks associated with osteoporosis and fragility fractures in nationwide data. Bone. 2026;118014.
Featured image: puhimec on Adobe Stock
Each article is made available under the terms of the Creative Commons Attribution-Non Commercial 4.0 License.
