Increased risk of incident osteoporosis and osteoporotic fracture in tuberculosis patients: a population-based study in a tuberculosis-endemic area.
The occurrence of osteoporosis in tuberculosis, a chronic infection, has rarely been evaluated. In this study, we found significantly higher incidence rates of osteoporosis (Adjusted hazard ratio ﻿(AHR) 1.82) and osteoporotic fracture (AHR 2.33) in tuberculosis patients than matched cohorts, which suggest that osteoporosis screening should be considered in tuberculosis patients' follow-up program. The aim of this study is to determine the occurrence of incident osteoporosis in patients who completed anti-tuberculosis (TB) treatment.



Chronic inflammatory disorders are associated with an increased risk of osteoporosis. Although TB is an infectious disease characterized by systemic inflammatory responses, the impact of active TB on incident osteoporosis is unclear. We used the Taiwan National Health Insurance Research Database to investigate the association between history of active TB and incident osteoporosis and osteoporotic fracture.



In this nationwide retrospective cohort study, active TB patients and their age- and sex-matched controls were identified from the National Health Insurance Research Database in Taiwan during 2000-2012. The occurrence of incident osteoporosis, osteoporotic fractures, and risk factors associated with osteoporosis among TB patients and matched controls were analyzed.



We observed incident osteoporosis in 2.2% (n = 86) of the TB patients and in 1.1% (n = 162) of the matched controls. The incidence rate of osteoporosis was 4.31 and 1.80 per 1000 person-years, which was significantly higher in TB patients (p < 0.001). In multivariate analysis, TB was an independent risk factor for osteoporosis. The other independent factors associated with osteoporosis were older age, female sex, chronic obstructive pulmonary disease, asthma, and lower income. Moreover, we demonstrated that the occurrence of osteoporotic fracture was significantly higher in TB patients.



Patients with a history of active TB have a higher incidence rate of osteoporosis and osteoporotic fracture.
Department of Chest Medicine, Taipei Veterans General Hospital, No. 201, Sec. 2, Shih-Pai Rd., Taipei, 11217, Taiwan.
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Chen
Department of Chest Medicine, Taipei Veterans General Hospital, No. 201, Sec. 2, Shih-Pai Rd., Taipei, 11217, Taiwan.|School of Medicine, National Yang-Ming University, Taipei, Taiwan.|Institute of Clinical Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan.
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Feng
Department of Chest Medicine, Taipei Veterans General Hospital, No. 201, Sec. 2, Shih-Pai Rd., Taipei, 11217, Taiwan.
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WY
Ting
School of Medicine, National Yang-Ming University, Taipei, Taiwan.|Section of Infectious Diseases, Taipei City Hospital, Taipei City Government, Taipei City, Taiwan.
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Yen
Center for prevention and treatment of occupational injury and diseases, Taipei Veterans General Hospital, Taipei, Taiwan.|Division of Clinical Toxicology and Occupational Medicine, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
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Chuang
Department of Chest Medicine, Taipei Veterans General Hospital, No. 201, Sec. 2, Shih-Pai Rd., Taipei, 11217, Taiwan.|School of Medicine, National Yang-Ming University, Taipei, Taiwan.|Institute of Physiology, National Yang-Ming University, Taipei, Taiwan.
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Pan
Department of Chest Medicine, Taipei Veterans General Hospital, No. 201, Sec. 2, Shih-Pai Rd., Taipei, 11217, Taiwan.|School of Medicine, National Yang-Ming University, Taipei, Taiwan.
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Su
Department of Chest Medicine, Taipei Veterans General Hospital, No. 201, Sec. 2, Shih-Pai Rd., Taipei, 11217, Taiwan. wjsu@vghtpe.gov.tw.|School of Medicine, National Yang-Ming University, Taipei, Taiwan. wjsu@vghtpe.gov.tw.|Chest Department, Taipei Veterans General Hospital, Taipei, Taiwan. wjsu@vghtpe.gov.tw.
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0000-0001-9581-6472
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Su
D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D015897:Comorbidity; D016208:Databases, Factual; D019353:Endemic Diseases; D005260:Female; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D010024:Osteoporosis / Q000453:epidemiology / Q000382:microbiology*; D058866:Osteoporotic Fractures / Q000453:epidemiology / Q000382:microbiology*; D012307:Risk Factors; D012959:Socioeconomic Factors; D013624:Taiwan / Q000453:epidemiology; D014376:Tuberculosis / Q000150:complications* / Q000453:epidemiology
Osteoporosis; Osteoporotic fracture; Taiwan; Tuberculosis