This nationwide retrospective analysis of Austrian inpatient claims data (2003–2014) mapped comorbidity networks around osteoporosis (ICD-10 M80/M81) by sex and age group (50–59, 60–69, 70–79 years) in 1,705,684 hospitalized patients, and assessed whether osteoporosis was systematically coded at the time of fracture-related hospitalizations across six major fracture types.
Females had far broader osteoporosis-linked comorbidity networks than males at every age (up to 330 vs. 164 co-diagnoses at 70–79 years). Hip fractures (S72) showed the strongest co-occurrence with osteoporosis—especially in females ≥60 years—while upper limb fractures (forearm S52, wrist/hand S62, humerus S42) and thoracic fractures had no significant osteoporosis co-diagnoses recorded in any age group. The M80–M81 co-occurrence was consistently stronger in males than females (e.g., OR 63.74 vs. 18.53 at ages 50–59), suggesting under-coding of osteoporosis in males.
- Retrospective claims data rely on administrative coding quality, which may not reflect clinical intent or actual diagnosis. - Study period ends in 2014, so findings may not reflect current coding or treatment practices. - Analysis is limited to inpatient hospitalizations; outpatient osteoporosis diagnoses and fracture management are not captured.
Osteoporosis is frequently missed in the medical record at the time of upper limb and thoracic fractures—recognized as early fragility fractures—especially in younger patients and males. Clinicians should actively consider and document osteoporosis during any fragility fracture hospitalization, not just after hip fracture, to close a persistent diagnostic gap.
