Calculator for Length of Use of Bisphosphonates (CLUB) - Diversity Supplement

Peripheral arterial disease (PAD is a major public health problem, particularly for older persons. Osteoporotic fractures are also common in older individuals, and cause substantial morbidity and mortality. A number of studies, including studies from my mentor for this project (PI of CLUB), have reported that there is an interrelationship between cardiovascular disease and osteoporosis. However, existing literature on the risk for these fractures in persons with PAD, and the consequences of these fractures is limited. This diversity supplement relates to specific aims 1 and 2 of the parent project (Calculator for Length of Use of Bisphosphonates (CLUB)) and will utilize Veterans Health Administration (VHA) data.The specific aims include: -Specific Aim 1. Determine the incidence of all clinical fractures, in particular lower extremity fractures, among the CLUB cohort with and without a diagnosis of PAD. Approach: Using the VA CLUB cohort of older individuals on BP therapy for osteoporosis, we will identify those with PAD based on ICD-9 and ICD-10 codes. We will collect available data on the ankle brachial index (ABI) and toe brachial index (TBI) as a further measure of both the presence and the severity of PAD. Specific Aim 2. Determine mortality and morbidity of persons with fractures with and without a diagnosis of PAD in CLUB. Approach: We will determine overall mortality in the VA CLUB cohort with and without a diagnosis of PAD and mortality at 1,3, 6, 12 months and yearly up to five years following the incident fracture. We will also determine, as a measure of morbidity, post fracture amputations in these groups. Specific Aim 3. Estimate healthcare costs associated with sustaining an osteoporotic fracture in the presence of PAD. Approach: We will estimate total health care costs for one year before and for one year following foreleg (tibia, fibula, ankle, and hindfoot fractures [excluding metatarsal and digital fractures]) in those with PAD and those without PAD. In each group the costs of fracture will be estimated as the total costs of care in the year following fracture minus the year before fracture. We will use methodology from and work with the VA Health Economics Resource Center (HERC) (HERC: Home (va.gov) to estimate costs of care in both groups over both time periods.