Patients with atopic eczema have an increased risk for fracture, especially major osteoporotic fractures, according to a recent study published in the Journal of Allergy and Clinical Immunology.
Katherine E. Lowe, from the London School of Hygiene and Tropical Medicine, and colleagues performed a matched cohort study involving adults with atopic eczema matched with up to five individuals without eczema to compare the risk for any fracture and major osteoporotic fractures individually. Data were included for 526,808 individuals with atopic eczema and 2,569,030 without atopic eczema. The researchers found that the risk for hip, pelvic, spinal, and wrist fractures was increased among those with eczema (hazard ratios, 1.10 [99% confidence interval, 1.06 to 1.14], 1.10 [1.02 to 1.19], 1.18 [1.10 to 1.27], and 1.07 [1.03 to 1.11], respectively). There was no evidence for increased proximal humeral fracture risk (hazard ratio, 1.06; 99% confidence interval, 0.97 to 1.15). With increasing eczema severity, increased fracture risk was noted, with the strongest correlation seen for those with severe eczema versus no eczema for spinal, pelvic, and hip fractures (hazard ratios, 2.09 [99% confidence interval, 1.66 to 2.65], 1.66 [1.26 to 2.20], and 1.50 [1.30 to 1.74], respectively). After adjustment for oral glucocorticoids, the associations persisted.
The substantial increase in the risk of spinal, hip, and pelvic fractures seen in those with severe atopic eczema should be of concern to physicians (more than double the risk of spinal fracture, 66% increased risk of pelvic fracture, and 50% increased risk of hip fracture) given the high morbidity and mortality associated with these fractures, the authors note.
Study results suggest that bone density screening guidelines should consider including individuals with more severe atopic eczema to prevent fractures, improve long-term quality of life, and reduce fracture-related health care costs.