In the Journals Plus

Osteomyelitis associated with higher rate of fragility fracture at any site

Show Citation

February 12, 2019

Among older men with osteomyelitis, the rate of fragility fracture at any major osteoporotic site is 78% higher compared with those without osteomyelitis, study findings showed.

Osteomyelitis is characterized by inflammatory destruction of bone tissue often resulting in chronic infection,” Evelyn Hsieh, MD, PhD, assistant professor of medicine and epidemiology at Yale School of Medicine, and colleagues wrote in Clinical Infectious Diseases. “We utilized a well-characterized cohort to determine whether rates of fracture at major osteoporotic fracture sites were higher in individuals with a history of osteomyelitis than without, taking into consideration established predictors of fractures.”

In their analysis, the researchers included men who were aged 50 to 70 years in 2000 who were enrolled in the Veterans Aging Cohort Study.

According to the study, 24,451 men were included in the final analysis. At or before the index visit in 2000, 2.13% of participants had an osteomyelitis diagnosis, with ankle and foot being the most common sites of infection, Hsieh and colleagues reported. Patients with osteomyelitis were slightly older and were more likely to be black.

The researchers noted that 5.2% of men with osteomyelitis had a previous history of fracture compared with 1.9% among men without the infection. Additionally, men with osteomyelitis were more likely to have a history of rheumatoid arthritis, current alcohol use, diabetes, 24.7% hepatitis C virus infection and HIV.

Over a 10-year period, 6.5% of men with osteomyelitis experienced fractures compared with 3.8% of those without osteomyelitis, according to study findings. More incident fractures at major osteoporosis sites occurred in men with osteomyelitis at the hip, upper arm and vertebrae, and for all but two men, the incident fracture occurred at a place distant from the osteomyelitis site.

Furthermore, the odd of experiencing a fracture at any major osteoporotic site were 1.78 times higher in men with osteomyelitis (95% CI, 1.25-2.54), Hsieh and colleagues reported.

“These data suggest that osteomyelitis is an independent and important risk for future fragility fracture in older men,” they concluded. “Further research is necessary to determine whether the mechanism is related to inflammation and systemic bone loss resulting in decreased bone strength, or other co-morbid factors such as HIV or deconditioning and increased fall risk.” – by Marley Ghizzone

Disclosures: Hsieh reports receiving honoraria from Gilead. Please see the study for all other authors’ relevant financial disclosures.