Dima Alina, Pedersen Alma Becic, Pedersen Lars, Baicus Cristian, Thomsen Reimar Wernich
Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark.
Department of Internal Medicine, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.
BMJ Open. 2018 Feb 8;8(2):e020680. doi: 10.1136/bmjopen-2017-020680.
To examine recent time trends in the incidence of osteonecrosis (ON) in Denmark and to investigate different common comorbidities association with ON in a population-based setting.
Using Danish medical databases, we included all patients with a first-time hospital diagnosis of ON during 1995-2012. Each ON case was matched with 10 randomly selected population control subjects from general population. For all participants, we obtained a complete hospital history of comorbidities included in the CharlsonComorbidity Index 5 years preceding the inclusion date.
4107 ON cases and 41 063 controls were included. The incidence of ON increased from 3.9 in 1995 to 5.5 in 2012 per 100 000 inhabitants. Solid cancer was the most common comorbidity, associated with an adjusted OR (aOR) for ON of 2.0 (95% CI 1.7 to 2.2). For advanced metastatic cancer, leukaemia and lymphoma, aORs of ON were 3.4 (95% CI 2.5 to 4.5), 4.3 (95% CI 2.7 to 7.0) and 5.8 (95% CI 4.3 to 7.8), respectively. Among other chronic conditions, aORs were 3.5 (95% CI 3.0 to 4.1) for connective tissue diseases and 2.3 (95% CI 2.0 to 2.7) for chronic pulmonary diseases. aORs were also increased at 2.8 (95% CI 1.9 to 4.1) and 4.5 (95% CI 2.5 to 8.2) for mild and moderate-to-severe liver disease, respectively, and 4.2 (95% CI 3.4 to 5.2) for renal disease.
This large population-based study provides evidence for an increasing ON incidence in the general population and documents an association between several common comorbid conditions and risk of ON.
研究丹麦骨坏死（ON）发病率的近期时间趋势，并在基于人群的背景下调查与ON相关的不同常见合并症。
利用丹麦医学数据库，我们纳入了1995年至2012年间首次住院诊断为ON的所有患者。每例ON病例与从普通人群中随机选取的10名对照受试者进行匹配。对于所有参与者，我们获取了入选日期前5年纳入Charlson合并症指数的完整合并症住院病史。
纳入了4107例ON病例和41063名对照。ON的发病率从1995年的每10万居民3.9例增加到2012年的5.5例。实体癌是最常见的合并症，ON的调整后比值比（aOR）为2.0（95%可信区间1.7至2.2）。对于晚期转移性癌、白血病和淋巴瘤，ON的aOR分别为3.4（95%可信区间2.5至4.5）、4.3（95%可信区间2.7至7.0）和5.8（95%可信区间4.3至7.8）。在其他慢性病中，结缔组织病的aOR为3.5（95%可信区间3.0至4.1），慢性肺病的aOR为2.3（95%可信区间2.0至2.7）。轻度和中度至重度肝病的aOR也分别增加到2.8（95%可信区间1.9至4.1）和4.5（95%可信区间2.5至8.2），肾病的aOR为4.2（95%可信区间3.4至5.2）。
这项基于大量人群的研究为普通人群中ON发病率的增加提供了证据，并记录了几种常见合并症与ON风险之间的关联。
