Epidemiology of osteonecrosis among older adults in Sweden

Abstract

Summary This study estimated the incidence of osteonecrosis in a Swedish, nationwide cohort of older adults. Osteonecrosis was approximately 10 times more common than in previous studies. The strongest risk factors were dialysis, hip fracture, osteomyelitis, and organ transplantation, but only hip fractures could have contributed substantially to the disease burden. Introduction The aim of this study was to estimate the incidence of osteonecrosis in a Swedish, nationwide cohort of older adults and in a large number of risk groups in that cohort. Methods In this retrospective cohort study, we included everyone who was aged 50 years or older and who was living in Sweden on 31 December 2005. We used Swedish national databases to collect data about prescription medication use, diagnosed medical conditions, and performed medical and surgical procedures. The study outcome was diagnosis of primary or secondary osteonecrosis at any skeletal site. The strength of risk factors was assessed using age- and sex-standardized incidence ratios (SIRs). Results The study cohort comprised 3,338,463 adults. The 10-year risk of osteonecrosis was 0.4% ( n = 13,425), and the incidence rate was 4.7 cases/10000 person-years (95% confidence interval [CI], 4.6 to 4.7 cases). The strongest risk factors for osteonecrosis were hip fracture (SIR, 7.98; 95% CI, 7.69–8.27), solid organ transplantation (SIR, 7.14; 95% CI, 5.59–8.99), dialysis (SIR, 6.65; 95% CI, 5.62–7.81), and osteomyelitis (SIR, 6.43; 95% CI, 5.70–7.23). A history of hip fracture was present in 21.7% of cases of osteonecrosis, but osteomyelitis, dialysis, and solid organ transplantation were present in only 0.5 to 2% of cases. Conclusions Osteonecrosis was approximately 10 times more common than a small number of previous population-based studies have suggested. The strongest risk factors for osteonecrosis were dialysis, hip fracture, osteomyelitis, and solid organ transplantation, but only hip fractures could have contributed substantially to the disease burden. Electronic supplementary material The online version of this article (10.1007/s00198-018-04826-2) contains supplementary material, which is available to authorized users.

Bone-Specific Drugs and Osteonecrosis of Sites Other Than the Jaw: A Nationwide Cohort Study

“…Finally, given the observational study design, the associations found are most likely influenced by different forms of bias and confounding. Thus, although a recent study in a similar cohort suggested that only hip fracture contribute substantially to the risk of osteonecrosis, there may be unknown confounders that could influence the associations found in the present study. With respect to previous fractures as a risk factor, it should also be noted that from registers it is not possible to determine if a previous fracture occurred at the same side as later osteonecrosis.…”

“…This possibility would produce a false association between BSD and osteonecrosis. However, it should be noted that this was not the case in a recent validation study, where 30 cases of osteonecrosis were validated for accuracy . Finally, given the observational study design, the associations found are most likely influenced by different forms of bias and confounding.…”

“…The study outcome was diagnosis of primary (idiopathic) or secondary osteonecrosis (ICD 10th Revision code M87), or avascular necrosis, made either during hospitalization or at a visit to a specialist physician. A recent validation study of the NPR concluded that 27 of 30 osteonecrosis diagnoses were correct, two likely correct, and only one incorrect …”

“…However, few studies have investigated whether BSDs also are associated with osteonecrosis of other sites (also known as avascular necrosis), and these studies showed conflicting results . Given the widespread use of BSDs and the fact that osteonecrosis of other skeletal sites is much more common, this possible association would be of importance to study further. In the present study, we examined whether use of BSDs is associated with an increased risk of osteonecrosis of sites other than the jaw in a Swedish nationwide cohort.…”

Cementless Femoral Neck Endoprosthesis Spiron in Men in Aspects of Clinical Status and Quality of Life in Average a 5-year Follow-up

“…Osteoarthritis is currently the fourth leading cause of disability in women and the eighth in men. Among the most common causes of osteoarthritis of the hip due to sterile femoral head necrosis are: chronic dialysis, femoral neck fracture, hip in ammation, immunosuppression in organ transplantation [1].Sterile osteonecrosis of the femoral head, as the second cause of osteoarthritis in young patients, is almost 10 times more common in the male population than earlier research results might suggest.This disease at such a young age is the reason for giving up physical activity, absenteeism from work and often is found in patients undergoing treatment for a "different" disease [1,2].…”