Jim Case

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Jim Case

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Pathological fractures, remaining issue:

Fractures occurring in the presence of disease have FSNs that state the disease is the cause of the fracture (e.g. Pathological fracture of femur due to neoplastic disease).  While the disease is a predisposing factor in the fracture, it is not directly the cause of the fracture.  Previously these concepts had been modeled using a DUE TO = Neoplastic disease or Osteoporosis.  They have since been remodeled to remove the DUE TO and have expressed the disease as a co-occurrence.  At a prior EAG meeting it was proposed to rename these concepts as below:

• Proposed naming as additional descriptions listed below:
  • Rename concepts with "Pathologic fracture of X due to osteoporosis" to "Osteoporotic fracture of X", to remove the causal DUE TO relations from the FSN.
  • Rename concepts with "Pathologic fracture of X due to neoplasia" to "Neoplastic fracture of X"

Question:  

Due to the remodeling of the terms and the proposed renaming, should these concepts be inactivated and replaced with terms that more accurately represent the condition. There is definitely a change in meaning with the removal of the DUE TO relationship and erroneous FSNs that explicitly represent causality.

Is simple renaming appropriate here?

Discussion:

Is there such a term as "Neoplastic fracture"?  It is used in the literature (not heavily), and it relates to the weakening of the bone by the neoplasm.  Need to be sure that what is meant by neoplastic fracture definitely means the fracture at the site of the neoplasm.  WRT osteoporosis, the meaning is essentially the same. The term neoplastic pathological fracture is also used. Is there an issue with translation?  In Spanish it translates easily. Neoplastic pathological fracture may be redundant. The question is how would the revised terms be interpreted?  Is there really a need to change the term even though the DUE To relationship has been removed?   While osteoporotic fracture is relatively well understood, Neoplastic fracture is less so. 

Following discussion, a few options for modeling fractures were discussed

Update 11/3/2020:  Based on the discussion and a consensus that fractures should be agnostic as to mechanism unless specifically stated in the FSN. The DUE TO = Traumatic event relationship has been removed from fracture concepts except where need to preserve proper inferences (e.g. open fractures are by definition traumatic and the DUE TO relationship is needed to classify under "Wound").  This results in pathologic and insufficiency fractures classifying as in prior releases under the fracture of the same bone.  This will appear in the Jan 2021 release.

• Jim Case to write up options for modeling fractures as a whole (i.e. agnostic to cause or traumatic)
• Jim Case  to update modeling of fractures as agnostic to mechanism
• Jim Case to propose an alternative naming for neoplastic fractures and communicate to the EAG

Farzaneh Ashrafi

Toni Morrison

Please see a preliminary review by Toni and I related to our work for identifying and modelling concepts that are defined by substance vs. medicinal product: https://docs.google.com/spreadsheets/d/1vtklSC3noLnLdQagDt4efbGawq5xp1XwnwPN0Zx_cu4/edit#gid=0

Our focus has been on "Poisoning", and its existing synonyms: toxic effect and intoxication, and "Overdose" (highlighted in green).

The suggested modelings and definitions may need changes/additional refinements in future when the broad scope of the associated ticket,  IHTSDO-310 - Getting issue details... STATUS , is fully reviewed and resolved. 

See "Poisoning and Overdose" presentation above.

We would appreciate any feedback you can provide on the proposed definitions before or during the EAG call on December 15, 2020.

• Farzaneh Ashrafi to update definitions and provide them for review by the EAG

Jim Case

Andrew Norton

• James R. Campbell and Andrew Norton to provide example of observables for assessment scales
• EAG to review document for examples of findings that clinicians would like to see

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