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Pemphigus patients prone to osteoporosis

Presented by
Dr Raj Chovatiya, Northwestern University Feinberg School of Medicine, USA
AAD 2019
Patients suffering from pemphigus or bullous pemphigoid often have various comorbidities [1]. They also are at risk for a lower bone mineral density through factors such as long-term steroid medication, inflammation, and low vitamin D.

Dr Raj Chovatiya (Northwestern University Feinberg School of Medicine, USA) and his colleagues investigated whether there is an association between the risk for osteoporosis or pathologic fractures and pemphigus or bullous pemphigoid patients, and also looked for fracture predictors. The authors analysed data from over 198 million people of all ages that received treatment in emergency rooms all over the USA from 2006-2012. Among these adults and children were 4,502 cases of pemphigus and 8,863 of bullous pemphigoid.

After adjusting for risk factors such as sex, age, income, previous long-term steroids, and insurance, there was still a significantly elevated risk of osteoporosis and pathologic fractures in pemphigus patients. The researchers found a 2.54-fold elevated relative risk for osteoporosis, a 2.2-fold elevated relative risk for osteopenia, a 2.04-fold elevated risk for general pathologic fractures, and a 1.46-fold elevated risk for pathologic femur or verbal fractures. The odds ratio for osteomalacia was very high, at 29.7. In patients with bullous pemphigoid, the odds for pathologic fractures and osteoporosis were also elevated (1.52 and 1.55).

The risks for osteoporosis and pathologic fractures were further increased by a history of long-term steroid use. In addition, female sex and increasing number of chronic diseases were identified as significant predictors for any fracture. Pemphigus or bullous pemphigoid patients with fractures had increased hospital admission rates. The total costs of care were significantly higher when a fracture occurred in these patients. Due to these results, the study authors concluded that there might be a possible benefit of fracture prevention and osteoporosis screening for patients suffering from these diseases.

1. Chovatiya R et al. ePoster No. 8514, AAD Annual Meeting, 1-5 March 2019, Washington DC, USA.

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