Respondents were similar to non-respondents in terms of fracture history, osteoporosis diagnosis, and osteoporosis treatment [9], as determined by self-reported data collected at baseline [10]. Data sources and measures Inhibitor Library supplier Study questionnaire

(self-report of drug use and DXA testing) As part of the standardized telephone interview completed in 2003/2004, we asked participants if they had ever had a bone density test and recorded information regarding osteoporosis pharmacotherapy (bisphosphonates, calcitonin, and raloxifene) and the use of other agents that may impact bone density (estrogen therapy, glucocorticoids, and thyroid medication) as current, past, or never. Question wording is included in the “Appendix.” DXA confirmation and DXA—documented osteoporosis DXA results were sought from participants who reported having had a DXA test and who completed a signed release of information form. For these patients, physicians were contacted to confirm that a DXA was completed and to obtain a copy of the most recent DXA report. We previously reported that the positive predictive value for self-report of having had a DXA was 93% when using physician responses as the gold standard [5]. Among those with a DXA report, we categorized

bone mineral density according to the lowest T-score at the lumbar spine (L1-4 or L2-4) or hip (femoral neck or total hip) as normal (T-score ≥ −1), osteopenic (−1 < T-score > −2.5), or osteoporotic (T-score ≤ −2.5) [11]. Healthcare utilization data—medical claims In Canada, physician and hospital services are funded through publicly financed comprehensive universal

health insurance. BIBW2992 In Ontario, claims for physician services are documented in the Ontario Health Insurance Plan (OHIP) Claims History Database. Information about inpatient services are captured in the Canadian Institutes of Health Information Discharge Abstract Database, and information about emergency department services are documented in the National Ambulatory Care Reporting System. Prior to April 1, 2002, hospital and emergency department records were coded using the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM). Mirabegron Since then, they have been coded using ICD-10-Canada (CA). July 1991 is the earliest date for which individual level data are available. DXA tests were identified using OHIP claim codes: J654, J655, J656, J688, J854, J855, J856, J888, X145, X146, X149, X152, X153, X155, and X157. These include codes for dual-photon absorptiometry, which predates DXA technology and was used prior to April 1998 [12]. We considered claims back to July 1991 when individual level claims data were first recorded in Ontario. Osteoporosis diagnosis was identified by any OHIP diagnosis code of 733 or any hospitalization or emergency department visit code of ICD-9-CM = 733.0 or ICD-10-CA = M80, M81, or M82. We considered diagnosis within 1 year pre- and post-DXA, as well as within 1 to 5 years before questionnaire completion.