Osteoporosis, Fracture Risk Elevated With Tuberculosis

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Tuberculosis was identified as an independent risk factor associated with incident osteoporosis.
Tuberculosis was identified as an independent risk factor associated with incident osteoporosis.

Patients with a history of tuberculosis (TB) have a higher rate of osteoporosis and osteoporotic fracture, according to a study published in Osteoporosis International.

Researchers at the Taipei Veterans General Hospital in Taipei, Taiwan sought to determine the association between a history of active TB and incident osteoporosis and osteoporotic fractures by examining retrospective data from a population-based nationwide cohort in Taiwan.

The study used patient data from the National Health Insurance Research Database (NHIRD), which is managed by the Taiwan National Health Research Institutes.

The researchers identified 4440 participants who had received a first diagnosis of TB between January 1, 2000 and December 31, 2012 who did not have comorbid osteoporosis. Active TB was validated by compatible ICD-9 codes and the prescription of at least 2 anti-TB drugs for >28 days. The mean study participant age in the TB cohort was 61.2 years.

Another 14,900 patients without TB or osteoporosis were utilized for the control cohort. The control cohort, 4 patients for each patient with TB, was matched by age, sex, and date of enrollment. The mean age in the matched control cohort was 58.6 years and 76.8% of the participants in both the TB cohort and the mean control cohort were male.

The mean study follow-up period was 5.4 years in the TB cohort and 6 years in the matched control cohort. In the TB cohort, 86 patients (2.2%) had developed osteoporosis, 2.36 (95% CI, 1.82-3.06, P <.05), and in the matched control cohort, 162 (1.1%) had a new onset of osteoporosis.

TB was found to be an independent risk factor associated with incident osteoporosis, with a hazard ratio (HR) of 1.82 (95% CI, 1.38-2.40, P <.05). 

The research also showed that patients diagnosed with TB with higher incomes had a lower risk of incident osteoporosis (HR 0.54; 95% CI,  0.33-0.88) and the HR was higher in the TB cohort population age 30 to 49 years (HR 4.90; 95% CI, 1.54-15.61), and patients in the TB cohort with chronic kidney disease (HR 4.83; 95% CI,  1.27-18.37).

In the TB cohort, 36 (0.97%) of the patients reported incident osteoporotic fracture, while in the matched control cohort, 56 (0.38%) of the patients reported osteoporotic fracture. The researchers found that TB was an independent risk factor for incident osteoporotic fracture (HR 2.33; 95% CI, 1.50-3.62).

“Considering the high morbidities and mortalities associated with osteoporosis and osteoporotic fracture, a well-organized screening program for osteoporosis should be established in TB patients with risk factors,” the researchers write.

“The aggressive management of osteoporosis is also warranted to prevent the occurrence of osteoporotic fractures in this vulnerable population.”

Reference

Cheng YY, Feng JY, Ting WY, et al. Increased risk of incident osteoporosis and osteoporotic fracture in tuberculosis patients: a population-based study in a tuberculosis-endemic area. Osteoporos Int. 2017; 28:1711-1721. doi:10.1007/s00198-017-3939-x

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