Comorbidity as a predictor of adverse osteoporosis outcomes
Abstract. Osteoporosis (OP) is often associated with cardiovascular disease (CVD) and type 2 diabetes mellitus (T2DM), which increases the impact of each on the risk of fractures. The aim: to assess the influence of CVD and T2DM on the incidence and structures of osteoporotic fractures in patients with postmenopausal OP. Material and methods. Retrospective and prospective cohort study (2013–2023) included 400 postmenopausal females seen in an outpatient setting: 300 patients with verified OP (study group) and 100 females without OP (control group). Participants were compared for age, duration of postmenopause, anthropometric parameters, bone mineral density (BMD), incidence of fractures at various sites, 10-year absolute risk of osteoporotic fractures according to the FRAX scale for the Russian Federation, Charlson index, and the prevalence of various CVDs and metabolic disorders. Results. In 300 female individuals with postmenopausal OP, the median lumbar spine BMD was approximately -3.2 SD versus -1.8 SD in 100 females without OP, and the median hip BMD was -2.9 SD versus -1.3 SD (p <0.001). Vertebral fractures in the past were observed in 214 (71.3%) patients with OP and none in the controls; the 10-year risk of major osteoporotic fractures according to FRAX was 37.0 and 9.55%, respectively (p <0.001). Charlson index was also higher in females with OP (5.0 [4.0; 7.0] vs. 2.0 [2.0; 3.0]; p <0.001), they more often had arterial hypertension of the 2nd (52.7 vs. 52.0%) and especially of the 3rd degree (39.8 vs. 30.9%; p = 0.007), angina pectoris of the 2nd functional class (24.2 vs. 2.7%) and chronic heart failure (CHF) of the 2nd functional class (32.5 vs. 20.0%; p = 0.014), a history of acute cerebrovascular accidents (18.7 vs. 5.0%; p = 0.011), as well as T2DM (25.3 vs. 13.6%; p = 0.016). A 1-point increase of Charlson index was associated with a statistically significant increase in the odds of OP. CHF and coronary heart disease were also its significant predictors. Furthermore, the presence of T2DM and obesity was associated with an increased odds ratio for OP, with confidence intervals for T2DM not including 1, and for obesity, tending toward significance. Conclusion. Patients with postmenopausal osteoporosis showed a significant BMD deficit and a high risk of recurrent fractures, combined with a significantly higher incidence of cardiovascular and metabolic comorbidities comparatively to females without OP.E.S. Zhugrova, V.I. Mazurov, I.B. Belyaeva, E.A. Trofimov, A.S. Trofimova, Yu.R. Parinskaya
Keywords
osteoporosis
comorbidity
fractures
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About the Authors
Elena S. Zhugrova, MD, PhD (Medicine), associate professor of the Department of therapy and rheumatology named after E.E. Eichwald, I.I. Mechnikov North-Western State Medical University, Saint Petersburg, Russian Federation.E-mail: jugrova@mail.ru
ORCID: https://orcid.org/0000-0002-8622-5205. eLibrary SPIN: 5504-3159
Vadim I. Mazurov, MD, Dr. Sci. (Medicine), professor, academician of RAS, Honored Scientist of the Russian Federation, vice president of RSMSIM, chief scientific advisor, director of the Research institute of rheumatology, head of the Department of therapy and rheumatology named after E.E. Eichwald, I.I. Mechnikov North-Western State Medical University; head of the Center for Autoimmune Diseases, V.A. Nasonova Clinical Rheumatology Hospital No. 25 (Saint Petersburg); chief external expert – rheumatologist at the Healthcare Committee of the Government of Saint Petersburg, Saint Petersburg, Russian Federation.
E-mail: maz.nwgmu@yandex.ru
ORCID: https://orcid.org/0000-0002-0797-2051. Scopus Author ID: 16936315400. eLibrary SPIN: 6823-5482
Irina B. Belyaeva, MD, Dr. Sci. (Medicine), professor of the Department of therapy and rheumatology named after
E.E. Eichwald, I.I. Mechnikov North-Western State Medical University, Saint Petersburg, Russian Federation.
Email: belib@mail.ru
ORCID: https://orcid.org/0000-0001-5261-6614. eLibrary SPIN: 3136-9062
Evgeny A. Trofimov, MD, Dr. Sci. (Medicine), professor, head of the Department of therapy and rheumatology named after E.E. Eichwald, I.I. Mechnikov North-Western State Medical University, Saint Petersburg, Russian Federation.
E-mail: Evgeniy.trofimov@szgmu.ru
ORCID: https://orcid.org/0000-0003-3236-4485. eLibrary SPIN: 4358-1663
Anna S. Trofimova, MD, PhD (Medicine), associate professor of the Department of therapy and rheumatology named after E.E. Eichwald, I.I. Mechnikov North-Western State Medical University, Saint Petersburg, Russian Federation.
E-mail: anna.trofimova@szgmu.ru
ORCID: https://orcid.org/0000-0001-5926-7912. eLibrary SPIN: 6827-3934. AuthorID: 973788
Yulia R. Parinskaya, MD, PhD (Medicine), associate professor of the Department of therapy and rheumatology named after E.E. Eichwald, I.I. Mechnikov North-Western State Medical University, Saint Petersburg, Russian Federation.
E-mail: ule8@yandex.ru
ORCID: https://orcid.org/0000-0001-8136-0697. eLibrary SPIN: 2048-3248
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