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Epidemiology of osteonecrosis among older adults in Sweden
Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Sustainable Health. School of Sport Sciences, UiT Arctic University of Norway, Postboks 1621, 9509, Alta, Norway.
Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
2019 (English)In: Osteoporosis International, ISSN 0937-941X, E-ISSN 1433-2965, Vol. 30, no 5, p. 965-973Article in journal (Refereed) Published
Abstract [en]

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.

Place, publisher, year, edition, pages
Springer London, 2019. Vol. 30, no 5, p. 965-973
Keywords [en]
Aseptic necrosis, Avascular necrosis, Bone necrosis, Register, Registry, Sweden
National Category
Geriatrics
Identifiers
URN: urn:nbn:se:umu:diva-155486DOI: 10.1007/s00198-018-04826-2ISI: 000467142400005PubMedID: 30627759Scopus ID: 2-s2.0-85059865604OAI: oai:DiVA.org:umu-155486DiVA, id: diva2:1280147
Available from: 2019-01-18 Created: 2019-01-18 Last updated: 2019-06-13Bibliographically approved

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Bergman, JonathanNordström, AnnaNordström, Peter

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