title: Increased Acquired Cholesteatoma Risk in Patients with Osteoporosis: A Retrospective Cohort Study.
abstract: OBJECTIVE
  Clinically, we found the increased incidence of acquired colesteatoma in the patients with osteoporosis. In this study, we used a retrospective cohort to examine this association and to investigate the possible mechanism.
  
  
  METHODS
  We conducted a population-based retrospective cohort study by using the National Health Insurance Research Database (NHIRD). We identified an osteoporosis cohort comprising 37 124 patients newly diagnosed with osteoporosis aged 20 years or older. Patients in the comparison cohort had no history of osteoporosis and were frequency matched with the patients in the osteoporosis cohort according to sex, age, and index year.
  
  
  RESULTS
  The acquired cholesteatoma incidence rates for the osteoporosis and comparison cohorts were 1.12 and 0.83 per 1000 person-years, respectively. After we adjusted for confounding factors, the osteoporosis cohort exhibited a 1.32-fold increased acquired cholesteatoma risk relative to the comparison cohort (hazard ratio [HR] = 1.32, 95% confidence interval [CI] = 1.11-1.57). In addition, patients with no history of otitis media (HR = 1.33, 95% CI = 1.11-1.59), cancer (HR = 1.34, 95% CI = 1.12-1.60), or COPD (HR = 1.26, 95% CI = 1.05-1.52) in the osteoporosis cohort exhibited an increased risk of subsequent acquired cholesteatoma relative to those in the comparison cohort.
  
  
  CONCLUSIONS
  Our cohort study indicated that patients with osteoporosis had a 1.31-fold increased acquired cholesteatoma risk relative to the comparison cohort. This risk was further increased in patients with comorbid otitis media. Hence, we recommend that otolaryngologists evaluate the condition of the middle ear of patients with osteoporosis.
authors.affiliation: Department of Otolaryngology Head and Neck Surgery, China Medical University Hospital, Taichung, Taiwan; Department of Otolaryngology Head and Neck Surgery, University of Iowa Hospital, Iowa City, IA, United States of America.
authors.forename: Tang-Chuan
authors.initials: TC
authors.lastname: Wang
authors.affiliation: Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan; College of Medicine, China Medical University, Taichung, Taiwan.
authors.forename: Che-Chen
authors.initials: CC
authors.lastname: Lin
authors.affiliation: Department of Otolaryngology Head and Neck Surgery, China Medical University Hospital, Taichung, Taiwan.
authors.forename: Chia-Der
authors.initials: CD
authors.lastname: Lin
authors.affiliation: Department of Otolaryngology Head and Neck Surgery, China Medical University Hospital, Taichung, Taiwan.
authors.forename: Hsiung-Kwang
authors.initials: HK
authors.lastname: Chung
authors.affiliation: Department of Otolaryngology Head and Neck Surgery, China Medical University Hospital, Taichung, Taiwan.
authors.forename: Ching-Yuang
authors.initials: CY
authors.lastname: Wang
authors.affiliation: Department of Otolaryngology Head and Neck Surgery, China Medical University Hospital, Taichung, Taiwan.
authors.forename: Ming-Hsui
authors.initials: MH
authors.lastname: Tsai
authors.affiliation: Graduate Institute of Clinical Medical Science and School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan; Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, Taiwan.
authors.forename: Chia-Hung
authors.initials: CH
authors.lastname: Kao
mesh_terms: D000368:Aged; D002781:Cholesteatoma / Q000150:complications* / Q000453:epidemiology*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D010024:Osteoporosis / Q000150:complications*; D012189:Retrospective Studies; D012307:Risk Factors