Adults With Eczema May Have Elevated Fracture Risk

Ricki Lewis, PhD

December 24, 2014

Eczema may increase the risk of sustaining fractures, according to a study published online December 13 in the Journal of Allergy and Clinical Immunology.

Nitin K. Garg, MD, from the Department of Dermatology, and Jonathan I. Silverberg, MD, PhD, MPH, from the Department of Dermatology, the Department of Preventive Medicine, and the Department of Medical Social Sciences, Northwestern University, Chicago, Illinois, hypothesized that eczema might contribute to elevated risk for fractures because of chronic inflammation and the use of topical and systemic corticosteroids. In addition, distraction from contorting oneself to scratch, interrupted sleep, and mental health comorbidities might increase risk for injuries and accidents.

Past studies to assess association between bone mineral density (BMD) in adults and eczema have had conflicting results and did not fully consider fracture risk, the researchers write.

In the current study, the investigators analyzed data from the 2005 to 2006 National Health and Nutrition Examination Survey, including surveys, physical exams, blood tests, and dual-energy X-ray absorptiometry.

The survey included information on corticosteroid use over the last month, time of osteoporosis diagnosis, tobacco and alcohol use, and history of eczema at any time, and of fractures after age 20 years. Reference standards were used for BMD for age, sex, and race/ethnicity.

The researchers used logistic regression models to analyze bivariate associations between eczema, fracture, metabolic factors, and sociodemographic variables and linear regression models for associations between eczema and BMD.

The study included 4972 people aged 20 to 85 years. The prevalence of eczema was 7.4% (95% confidence interval [CI], 6.5% - 8.3%). The prevalence of any fracture was 32.3% (95% CI, 30.7% - 33.9%), with the prevalence of hip or spine fractures being 3.9% (95% CI, 3.3% - 4.6%). Most of the adults with eczema and osteoporosis did not recall having received a diagnosis of osteoporosis in the past.

Eczema was associated with a significantly lower BMD score for the total femur, including the trochanter and the total lumbar spine, but not the femoral neck, and with osteopenia and osteoporosis of the trochanter, but not of the total femur, femoral neck, or total lumbar spine.

Adults with eczema also had 48% higher risk of fracture at any site, compared with adults without a history of eczema after adjusting for other factors (adjusted odds ratio [aOR], 1.48; 95% CI, 1.10 - 1.99; P = .01). They also had an elevated risk for hip or spine fracture (aOR, 1.87; 95% CI, 1.02-3.43; P = .04).

Osteoporosis was associated with daily oral corticosteroid treatment for a month or longer at any time (aOR, 1.44; 95% CI, 1.05 - 1.99; P = .02).

The researchers suggest that adults with eczema might benefit from dual-energy X-ray absorptiometry scans, especially because osteoporosis seems to be underdiagnosed, based on their data. In addition, patients with eczema should be educated on identifying and lowering risk factors for osteoporosis, they say.

Limitations of the study include the fact that only a few participants reported current use of corticosteroids. Associations of comorbid psychological and behavioral diseases and sleep disturbance require further investigation, the researchers write.

The authors have disclosed no relevant financial relationships.

J Allergy Clin Immunol. Published online December 13, 2014. Abstract


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