Association of common comorbidities with osteonecrosis: a nationwide population-based case–control study in Denmark

Abstract

ObjectiveTo examine recent time trends in the incidence of osteonecrosis (ON) in Denmark and to investigate different common comorbidities association with ON in a population-based setting.MethodsUsing Danish medical databases, we included all patients with a first-time hospital diagnosis of ON during 1995–2012. Each ON case was matched with 10 randomly selected population control subjects from general population. For all participants, we obtained a complete hospital history of comorbidities included in the CharlsonComorbidity Index 5 years preceding the inclusion date.Results4107 ON cases and 41 063 controls were included. The incidence of ON increased from 3.9 in 1995 to 5.5 in 2012 per 100 000 inhabitants. Solid cancer was the most common comorbidity, associated with an adjusted OR (aOR) for ON of 2.0 (95% CI 1.7 to 2.2). For advanced metastatic cancer, leukaemia and lymphoma, aORs of ON were 3.4 (95% CI 2.5 to 4.5), 4.3 (95% CI 2.7 to 7.0) and 5.8 (95% CI 4.3 to 7.8), respectively. Among other chronic conditions, aORs were 3.5 (95% CI 3.0 to 4.1) for connective tissue diseases and 2.3 (95% CI 2.0 to 2.7) for chronic pulmonary diseases. aORs were also increased at 2.8 (95% CI 1.9 to 4.1) and 4.5 (95% CI 2.5 to 8.2) for mild and moderate-to-severe liver disease, respectively, and 4.2 (95% CI 3.4 to 5.2) for renal disease.ConclusionThis large population-based study provides evidence for an increasing ON incidence in the general population and documents an association between several common comorbid conditions and risk of ON.

Epidemiology of osteonecrosis among older adults in Sweden

“…The strongest risk factors for osteonecrosis were dialysis, osteomyelitis, hip fracture, and solid organ transplantation. Few previous studies have estimated the incidence of osteonecrosis in a general population, but two studies that did, one in Denmark and one in the UK, showed yearly rates of 1/10th or less than our study did [ 14 , 15 ]. Our cohort was older, but this difference cannot explain the entire difference because the UK study showed a considerably lower incidence in older adults as well [ 15 ].…”

“…Our cohort was older, but this difference cannot explain the entire difference because the UK study showed a considerably lower incidence in older adults as well [ 15 ]. Possible explanations for the difference in incidence include geographic variation, a greater propensity of Swedish physicians to diagnose osteonecrosis, and a more complete coverage of specialist health care in the database we used to identify osteonecrosis, although the Danish study used a similar national database [ 14 ].…”

“…The current study showed a history of hip fracture in 22% of older adults diagnosed with osteonecrosis at any skeletal site. Previous large, population-based studies of osteonecrosis did not report the prevalence of hip fracture [ 14 , 15 ], and a single-center study of osteonecrosis of the femoral head attributed only 13% of cases to hip fractures [ 22 ]. Hip fracture is a well-known risk factor for osteonecrosis of the femoral head, and the risk varies depending on the type of hip fracture and surgical procedure [ 32 , 33 ].…”

“…Risk factors for osteonecrosis include fractures [ 3 – 5 ], radiation [ 6 , 7 ], corticosteroids [ 8 , 9 ], excess alcohol consumption [ 10 ], and a large number of medical conditions [ 1 , 2 , 11 – 13 ]. The incidence of osteonecrosis in general populations is uncertain because there have been few large, population-based studies and because these few studies primarily estimated the prevalence of osteonecrosis and the incidence of particular types of osteonecrosis [ 14 – 19 ]. The incidence has not been comprehensively assessed in risk groups, as previous studies considered only one risk group or a limited number of risk factors [ 5 – 7 , 14 , 15 , 20 – 24 ].…”

Bone-Specific Drugs and Osteonecrosis of Sites Other Than the Jaw: A Nationwide Cohort Study

“…Patients with osteonecrosis often need surgery and often suffer from pain, reduced mobility, and increased dependency . Recently, we reported that the incidence of osteonecrosis is about 10 times more common than previous studies have suggested, a finding that increases the clinical relevance of osteonecrosis. In the present study, the incidence of osteonecrosis of any site was 0.16% per year of exposure to BSD, although it was more than twice as high for patients taking zoledronic acid or denosumab.…”