1. * Or unknown (n=8) Inbal Goldshtein 1, Julie Chandler 2, Varda Shalev 1,3, Sofia Ish –Shalom 4, Allison Martin Nguyen 2, Vanessa Rouach 5, Gabriel Chodick 1,3 1. Maccabi Healthcare Services, Tel Aviv, Israel 2. Merck and Co, Inc, PA, USA 3. Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel 4. Technion-Israel Institute of Technology, Haifa, Israel 5. Institute of Hypertension, Metabolism, and Endocrinology, Souraski Medical Center, Tel Aviv, Israel Objective Osteoporosis is a growing public health concern due to its rising prevalence and excess morbidity and mortality. Automated patient registries have gained great importance in health and disease management of major chronic diseases, but are rarely used in osteoporosis. The purpose of the current study was to construct a registry of osteoporosis patients using the databases of Maccabi Healthcare Services, a 2 million member health organization in Israel. OSTEOPOROSIS IN THE COMMUNITY FINDINGS FROM A NOVEL REGISTRY IN A LARGE HEALTH ORGANIZATION IN I SRAEL Methods Included in the registry are adult patients with osteoporosis diagnosis, major osteoporotic fractures, or purchases of relevant medications, documented since 2000. In addition, we included patients with low bone density as extracted from over 140,000 measurements reports, using an automated Optical Character Recognition (OCR) system. Two-thirds of the cases were validated by more than one qualifying criteria. Results In 2013, the registry identified 118,141 patients, with a point prevalence of 19% in 2013 among members aged 50 and an annual incidence of approximately 6,100 osteoporosis cases (peak of 27 per 1000 in females aged 65-75). In 2013, the mean (SD) age at registry entry was 61(SD) and 66 (SD) years for females and males, respectively. 28% of the registry patients had no indication of treatment with prescription osteoporosis therapy. Conclusions To the best of our knowledge, this is one of the first real-world automated registries of osteoporosis. It reveals the immense burden of osteoporosis in the community, and can serve as a fertile ground of valuable data for real-time monitoring of trends, quality of care, and outcome research in osteoporosis and its complications. Table 1-Demographics and comorbidities of osteoporosis patients with age and sex standardized morbidity ratios (SMR) compared to the general population in Maccabi healthcare services, 2013 OP registry Demography Sex, % females85% Age, Mean ± SD69 ± 12 SES, Mean ± SD12 ± 5 BMI, Mean ± SD28 ± 6 T-score, Median ± SD Femur neck-1.9 ± 0.8 Total hip-1.6 ± 0.9 Vertebrae-1.8 ± 1.3 History of prolonged GC use, %6% Registry entry year, n (%) <=200129,727 (31%) 2002-200418,529 (19%) 2005-200715,737 (16%) 2008-201018,427 (19%) 2011-201314,988 (15%) Comorbidities SMR (95% CI) Coronary heart disease, %7.5%1.07 (1.05-1.09) Hypertension, %56.0%0.99 (0.98-0.99) Diabetes, %19.6%0.90 (0.89-0.92) COPD, %6.5%1.32 (1.28-1.35) Vitamin D Insufficiency, %25.1%0.79 (0.78-0.80) Renal impairment, %2.0%0.96 (0.92-1.00) Crohn's disease, %2.6%1.54 (1.48-1.60) Ulcerative Colitis, %10.3%1.25 (1.22-1.27) Recent depression19.0%1.18 (1.16-1.19) Obesity25.0%0.83 (0.82-0.84) Table 2- age and sex specific prevalence rates per 1000 of osteoporosis in Maccabi healthcare services, Israel, 2013 Age 50-54 55 - 6465 - 7475 - 8485+ age 50+ Spine Males 0 1111929 6 Females 2 8215072 18 Humerus Males 0 161323 4 Females 2 10244968 19 Hip Males 0 172154 6 Females 0 41142133 15 Colles Males 0 2111725 6 Females 7 28517594 37 Any of the above Males 0 53365118 20 Females 11 4899186301 78 Age18- 4545 – 5455 – 6465 – 7475 – 8485+ Total age 18+ Total age 50+ females, 60+ males Males31027921732452398 Females770239462600622117314 Table 3- age and sex specific prevalence rates per 1000 of major osteoporotic fractures in Maccabi healthcare services, Israel, 2013 Inclusion criteria metn% of registry 1. OP diagnosis + medication + fracture15,16913% 2. OP diagnosis + medication or +pathologic BMD54,34546% 3. OP diagnosis + fracture4,3964% 4. Medication + fracture Or +pathologic BMD2,7662% 5. BMD alone1,0381% 6. Medication alone14,25312% 7. OP diagnosis alone13,51711% 8. Major osteoporotic fracture alone12,65711% Table 4- distribution of inclusion criteria Figure 1- Age and sex specific all-cause mortality rates within 1 year from osteoporotic fracture event,, Maccabi healthcare services, Israel, 2000-2013