Highlights from

AAD 2019

American Academy of Dermatology annual meeting

Washington D.C. 1-5 March 2019

Pemphigus patients prone to osteoporosis

A cross-sectional cohort study found an elevated risk for pathologic fractures, osteopenia, and osteoporosis in patients with a diagnosis of pemphigus or bullous pemphigoid.

Patients suffering from pemphigus (PEM) or bullous pemphigoid (BP) often have various comorbidities. They are also at risk for a lower bone mineral density through factors like long-term steroid medication, inflammation, and low vitamin D. Dr Raj Chovatiya (Northwestern University Feinberg School of Medicine, Chicago, USA) and his colleagues investigated whether there is an association between the risk for osteoporosis or pathologic fractures in pemphigus or bullous pemphigoid patients and also looked for fracture predictors [1]. They analysed data from over 198 million people of all ages that received treatment in emergency rooms all over the US 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 for 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 even 29.7. In patients with bullous pemphigoid, the odds for pathologic fractures and osteoporosis were also raised (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 authors conclude that there might be a benefit in fracture prevention and osteoporosis screening for patients suffering from these diseases.

  1. Chovatiya R et al. Association of Pemphigus and Bullous Pemphigoid with Osteoporosis and Pathological Fractures. ePoster No. 8514. AAD Annual Meeting. Washington DC, 1-5 March 2019.

Top image: © Zoranm

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