Park S H, Yoon S R, Nam J Y, Ahn J Y, Jeong S J, Ku N S, Choi J Y, Yeom J-S, Kim J H
Chaum Life Center, CHA University, Seoul 06062, South Korea; Department of Internal Medicine, National Health Insurance Service Ilsan Hospital, Goyang 10444, South Korea.
Institute of Health Insurance and Clinical Research, National Health Insurance Service Ilsan Hospital, Goyang 10444, South Korea.
Public Health. 2023 Mar;216:13-20. doi: 10.1016/j.puhe.2022.12.009. Epub 2023 Feb 7.
Despite the high prevalence of tuberculosis (TB) and the disease burden of osteoporosis and osteoporotic fractures, there is still a lack of well-designed, large-scale studies demonstrating associations among them. We aimed to investigate the effect of TB on the incidence of osteoporosis and osteoporotic fractures.
This was a nationwide population-based cohort study.
This study was conducted using the National Health Insurance Service Database of South Korea. We included patients with newly diagnosed TB aged >40 years from January 2006 to December 2017. An uninfected control for each TB patient was randomly extracted by frequency matching for sex, age, income level, residence, and registration date at a 2:1 ratio. The primary outcome was the incidence of osteoporosis and osteoporotic fractures between the two groups, adjusted for sex, age, income level, residence, comorbidities, body mass index, blood pressure, laboratory tests, alcohol drinking, and smoking. The risk factors associated with osteoporosis or osteoporotic fractures were also investigated.
A total of 164,389 patients with TB and 328,778 matched controls were included (71.9% males). The mean duration of follow-up was 7.00 ± 3.49 years. The incidence of osteoporosis in patients with TB was 6.1 cases per 1000 person-years, which was significantly higher than that in matched controls (adjusted hazard ratio [aHR] 1.349, 95% confidence interval [CI] 1.302-1.398, P < 0.001). The incidence of osteoporotic fractures was also higher in patients with TB than in controls (aHR 1.392, 95% CI 1.357-1.428, P < 0.001). Among fractures, the risk of hip fracture was the highest (aHR 1.703, 95% CI 1.612-1.798, P < 0.001).
TB independently contributes to the incidence of osteoporosis and osteoporotic fractures, particularly hip fractures.
尽管结核病（TB）的患病率很高，且骨质疏松症和骨质疏松性骨折的疾病负担较重，但仍缺乏设计良好的大规模研究来证明它们之间的关联。我们旨在研究结核病对骨质疏松症和骨质疏松性骨折发病率的影响。
这是一项基于全国人群的队列研究。
本研究使用韩国国民健康保险服务数据库进行。我们纳入了2006年1月至2017年12月期间新诊断出的年龄大于40岁的结核病患者。通过按性别、年龄、收入水平、居住地和登记日期以2:1的比例进行频率匹配，为每位结核病患者随机抽取一名未感染的对照。主要结局是两组之间经性别、年龄、收入水平、居住地、合并症、体重指数、血压、实验室检查、饮酒和吸烟调整后的骨质疏松症和骨质疏松性骨折的发病率。还对与骨质疏松症或骨质疏松性骨折相关的危险因素进行了调查。
共纳入164389例结核病患者和328778例匹配对照（男性占71.9%）。平均随访时间为7.00±3.49年。结核病患者的骨质疏松症发病率为每1000人年6.1例，显著高于匹配对照（调整后风险比[aHR]1.349，95%置信区间[CI]1.302 - 1.398，P<0.001）。结核病患者的骨质疏松性骨折发病率也高于对照（aHR 1.392，95%CI 1.357 - 1.428，P<0.001）。在骨折中，髋部骨折的风险最高（aHR 1.703，95%CI 1.612 - 1.798，P<0.001）。
结核病独立导致骨质疏松症和骨质疏松性骨折的发生，尤其是髋部骨折。
