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Multimorbidity in women with and without osteoporosis: results from a large US retrospective cohort study 2004–2009

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Abstract

Summary

To determine the incidence of comorbidities in women with and without osteoporosis, incidence rates per 1,000 person-years were calculated using electronic health records from an integrated healthcare system. The overall comorbidity burden and health service utilization were greater in women with osteoporosis than in the controls.

Introduction

This retrospective cohort study describes the incidence of an array of comorbidities in women with and without osteoporosis (OP).

Methods

Using electronic health records from an integrated healthcare system, we identified 22,414 women aged 55–89 years with OP and 22,414 age-matched controls without OP. Incidence rates (IRs) per 1,000 person-years (P-Y) were calculated and 95 % confidence intervals (CI) were estimated.

Results

Women with OP had significantly more comorbidities, medications, hospitalizations, and outpatient visits than the controls. Most cardiac comorbidity rates were 20–25 % lower in the OP cohort than in the control cohort. Hypertension had the largest rate difference; the IR was 42.0 per 1,000 P-Y (95 % CI 40.2–44.0) in the OP cohort compared to 94.0 (95 % CI 90.7–97.4) in the control cohort. Rates for cerebrovascular disease were similar for both cohorts at 26 per 1,000 P-Y. Bronchitis, sinusitis, and cystitis were each 55 per 1,000 P-Y in the OP cohort, whereas they ranged from 28 to 34 per 1,000 P-Y in the controls. The OP cohort had decreased incidence of ovarian, uterine, colorectal, and liver cancers and increased incidence of lung cancer, breast cancer, and multiple myeloma, compared to the non-OP cohort. Falls, depression, vision, and musculoskeletal issues were higher for the OP cohort than the controls.

Conclusions

This study demonstrates the high disease burden in women with OP. This knowledge may help guide the clinical management of this population and may aid in the interpretation of adverse events in randomized clinical trials of OP therapies.

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References

  1. van den Akker M, Buntinx F, Metsemakers JF, Roos S, Knottnerus JA (1998) Multimorbidity in general practice: prevalence, incidence, and determinants of co-occurring chronic and recurrent diseases. J Clin Epidemiol 51:367–375

  2. Barnett K, Mercer SW, Norbury M, Watt G, Wyke S, Guthrie B (2012) Epidemiology of multimorbidity and implications for health care, research, and medical education: a cross-sectional study. Lancet 380:37–43

    Article  PubMed  Google Scholar 

  3. van den Akker M, Buntinx F, Knottnerus JA (1996) Comorbidity or multimorbidity: what's in a name? A review of literature. Eur J Gen Pract 2:65–70

    Article  Google Scholar 

  4. Thayer SW, Stolsheck BS, Gomez Rey G, Seare J (2013) Impact of osteoporosis on high cost chronic diseases. Value Health 17:43–50

    Article  Google Scholar 

  5. Diem SJ, Blackwell TL, Stone KL, Yaffe K, Haney EM, Bliziotes MM, Ensrud KE (2007) Use of antidepressants and rates of hip bone loss in older women: the study of osteoporotic fractures. Arch Intern Med 167:1240–1245

    Article  PubMed  Google Scholar 

  6. Mussolino ME, Madans JH, Gillum RF (2003) Bone mineral density and stroke. Stroke 34:e20–e22

    Article  PubMed  Google Scholar 

  7. Whooley MA, Kip KE, Cauley JA, Ensrud KE, Nevitt MC, Browner WS (1999) Depression, falls, and risk of fracture in older women. Study of osteoporotic fractures research group. Arch Intern Med 159:484–490

    Article  CAS  PubMed  Google Scholar 

  8. Cauley JA, Lucas FL, Kuller LH, Vogt MT, Browner WS, Cummings SR (1996) Bone mineral density and risk of breast cancer in older women: the study of osteoporotic fractures. Study of Osteoporotic Fractures research group. JAMA 276:1404–1408

  9. Farhat GN, Newman AB, Sutton-Tyrrell K, Matthews KA, Boudreau R, Schwartz AV, Harris T et al (2007) The association of bone mineral density measures with incident cardiovascular disease in older adults. Osteoporos Int 18:999–1008

    Article  CAS  PubMed  Google Scholar 

  10. Nguyen TV, Center JR, Eisman JA (2000) Association between breast cancer and bone mineral density: the Dubbo Osteoporosis Epidemiology Study. Maturitas 36:27–34

    Article  Google Scholar 

  11. Newman ED, Ayoub WT, Starkey RH, Diehl JM, Wood GC (2003) Osteoporosis disease management in a rural health care population: hip fracture reduction and reduced costs in postmenopausal women after 5 years. Osteoporos Int 14:146–151

  12. Gold EB, Crawford SL, Avis NE, Crandall CJ, Matthews KA, Waetjen LE, Lee JS et al (2013) Factors related to age at natural menopause: longitudinal analyses from swan. Am J Epidemiol 178:70–83

    Article  PubMed Central  PubMed  Google Scholar 

  13. Warriner AH, Patkar NM, Curtis JR, Delzell E, Gary L, Kilgore M, Saag K (2011) Which fractures are most attributable to osteoporosis? J Clin Epidemiol 64:46–53

    Article  PubMed  Google Scholar 

  14. Elixhauser A, Steiner C, Palmer L (2014) Clinical classification software (ccs). US Agency for Healthcare Research and Quality: http://hcup-usahrqgov/toolssoftware/ccs/ccsjsp

  15. Dobson AJ, Kuulasmaa K, Eberle E, Scherer J (1991) Confidence intervals for weighted sums of Poisson parameters. Stat Med 10:457–462

    Article  CAS  PubMed  Google Scholar 

  16. Ulm K (1990) A simple method to calculate the confidence interval of a standardized mortality ratio (SMR). Am J Epidemiol 131:373–375

    CAS  PubMed  Google Scholar 

  17. Guggina P, Flahive J, Hooven FH, Watts NB, Siris ES, Silverman S, Roux C et al (2012) Characteristics associated with anti-osteoporosis medication use: data from the Global Longitudinal Study of Osteoporosis in Women (glow) USA cohort. Bone 51:975–980

    Article  PubMed  Google Scholar 

  18. Michaelsson K, Nordstrom P, Nordstrom A, Garmo H, Byberg L, Pedersen NL, Melhus H (2014) Impact of hip fracture on mortality: a cohort study in hip fracture discordant identical twins. J Bone Miner Res 29:424–431

    Article  PubMed  Google Scholar 

  19. Lo JC, Pressman AR, Omar MA, Ettinger B (2006) Persistence with weekly alendronate therapy among postmenopausal women. Osteoporos Int 17:922–928

    Article  CAS  PubMed  Google Scholar 

  20. Reams BD, O'Malley CD, Critchlow CW, Lauffenburger JC, Brookhart MA (2013) Changing patterns of use in osteoporosis medications in the years after launch: implications for comparative effectiveness research. Pharmacoepidemiol and Drug Saf In Press

  21. Tulner LR, Kuper IM, Frankfort SV, van Campen JP, Koks CH, Brandjes DP, Beijnen JH (2009) Discrepancies in reported drug use in geriatric outpatients: relevance to adverse events and drug-drug interactions. Am J Geriatr Pharmacother 7:93–104

    Article  PubMed  Google Scholar 

  22. Browner WS, Pressman AR, Nevitt MC, Cauley JA, Cummings SR (1993) Association between low bone density and stroke in elderly women. The Study of Osteoporotic Fractures. Stroke 24:940–946

  23. Samelson EJ, Kiel DP, Broe KE, Zhang Y, Cupples LA, Hannan MT, Wilson PW et al (2004) Metacarpal cortical area and risk of coronary heart disease: the Framingham Study. Am J Epidemiol 159:589–595

    Article  PubMed  Google Scholar 

  24. Magnus JH, Broussard DL (2005) Relationship between bone mineral density and myocardial infarction in US adults. Osteoporos Int 16:2053–2062

    Article  PubMed  Google Scholar 

  25. Arnold AM, Psaty BM, Kuller LH, Burke GL, Manolio TA, Fried LP, Robbins JA et al (2005) Incidence of cardiovascular disease in older Americans: the Cardiovascular Health Study. J Am Geriatr Soc 53:211–218

    Article  PubMed  Google Scholar 

  26. Hanley DA, Brown JP, Tenenhouse A, Olszynski WP, Ioannidis G, Berger C, Prior JC et al (2003) Associations among disease conditions, bone mineral density, and prevalent vertebral deformities in men and women 50 years of age and older: cross-sectional results from the Canadian Multicentre Osteoporosis Study. J Bone Miner Res 18:784–790

  27. Cesari M, Penninx BW, Lauretani F, Russo CR, Carter C, Bandinelli S, Atkinson H et al (2004) Hemoglobin levels and skeletal muscle: results from the InCHIANTI Study. J Gerontol A Biol Sci Med Sci 59:249–254

    Article  PubMed  Google Scholar 

  28. Chen Z, Thomson CA, Aickin M, Nicholas JS, Van Wyck D, Lewis CE, Cauley JA et al (2010) The relationship between incidence of fractures and anemia in older multiethnic women. J Am Geriatr Soc 58:2337–2344

    Article  PubMed Central  PubMed  Google Scholar 

  29. Whitson HE, Sanders L, Pieper CF, Gold DT, Papaioannou A, Richards JB, Adachi JD et al (2008) Depressive symptomatology and fracture risk in community-dwelling older men and women. Aging Clin Exp Res 20:585–592

    Article  PubMed Central  PubMed  Google Scholar 

  30. Taylor AJ, Gary LC, Arora T, Becker DJ, Curtis JR, Kilgore ML, Morrisey MA et al (2011) Clinical and demographic factors associated with fractures among older Americans. Osteoporos Int 22:1263–1274

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  31. Thapa PB, Gideon P, Cost TW, Milam AB, Ray WA (1998) Antidepressants and the risk of falls among nursing home residents. N Engl J Med 339:875–882

    Article  CAS  PubMed  Google Scholar 

  32. Liu B, Anderson G, Mittmann N, To T, Axcell T, Shear N (1998) Use of selective serotonin-reuptake inhibitors or tricyclic antidepressants and risk of hip fractures in elderly people. Lancet 351:1303–1307

    Article  CAS  PubMed  Google Scholar 

  33. Coleman AL, Stone K, Ewing SK, Nevitt M, Cummings S, Cauley JA, Ensrud KE et al (2004) Higher risk of multiple falls among elderly women who lose visual acuity. Ophthalmology 111:857–862

    Article  PubMed  Google Scholar 

  34. Cummings SR, Nevitt MC, Browner WS, Stone K, Fox KM, Ensrud KE, Cauley J et al (1995) Risk factors for hip fracture in white women. Study of Osteoporotic Fractures Research Group. N Engl J Med 332:767–773

    Article  CAS  PubMed  Google Scholar 

  35. Nattinger AB, McAuliffe TL, Schapira MM (1997) Generalizability of the surveillance, epidemiology, and end results registry population: factors relevant to epidemiologic and health care research. J Clin Epidemiol 50:939–945

    Article  CAS  PubMed  Google Scholar 

  36. Ji J, Sundquist K, Sundquist J (2012) Cancer risk after hospitalization for osteoporosis in Sweden. Eur J Cancer Prev 21:395–399

    Article  PubMed  Google Scholar 

  37. McGlynn KA, Gridley G, Mellemkjaer L, Brinton LA, Anderson KC, Caporaso NE, Landgren O et al (2008) Risks of cancer among a cohort of 23,935 men and women with osteoporosis. Int J Cancer 122:1879–1884

    Article  CAS  PubMed  Google Scholar 

  38. Edwards CM, Zhuang J, Mundy GR (2008) The pathogenesis of the bone disease of multiple myeloma. Bone 42:1007–1013

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  39. van der Klift M, de Laet CE, Coebergh JW, Hofman A, Pols HA, Rotterdam S (2003) Bone mineral density and the risk of breast cancer: the Rotterdam Study. Bone 32:211–216

    Article  PubMed  Google Scholar 

  40. Zhang Y, Kiel DP, Kreger BE, Cupples LA, Ellison RC, Dorgan JF, Schatzkin A et al (1997) Bone mass and the risk of breast cancer among postmenopausal women. N Engl J Med 336:611–617

    Article  CAS  PubMed  Google Scholar 

  41. Buist DS, LaCroix AZ, Barlow WE, White E, Cauley JA, Bauer DC, Weiss NS (2001) Bone mineral density and endogenous hormones and risk of breast cancer in postmenopausal women (United States). Cancer Causes Control 12:213–222

    Article  CAS  PubMed  Google Scholar 

  42. Stewart A, Kumar V, Torgerson DJ, Fraser WD, Gilbert FJ, Reid DM (2005) Axial BMD, change in BMD and bone turnover do not predict breast cancer incidence in early postmenopausal women. Osteoporos Int 16:1627–1632

    Article  CAS  PubMed  Google Scholar 

  43. Tremollieres FA, Pouilles JM, Laparra J, Ribot C (2008) Bone mineral density at menopause does not predict breast cancer incidence. Osteoporos Int 19:1497–1504

    Article  CAS  PubMed  Google Scholar 

  44. Langer RD, White E, Lewis CE, Kotchen JM, Hendrix SL, Trevisan M (2003) The Women's Health Initiative Observational Study: baseline characteristics of participants and reliability of baseline measures. Ann Epidemiol 13:S107–S121

    Article  PubMed  Google Scholar 

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Acknowledgments

This study was funded by Amgen Inc. Lisa A. Humphries of Amgen Inc. provided assistance with formatting and submission.

Conflicts of interest

Amgen Inc. funded this study. C.D. O’Malley, N. Tran, C. Zapalowski, and N. Daizadeh are employees of Amgen Inc. and have Amgen Inc. stock and/or stock options. T.P. Olenginski consults for Amgen Inc. J.A. Cauley has no conflicts of interest to declare.

Author information

Authors and Affiliations

  1. Amgen Inc., MS: ASF 2 1120 Veterans Blvd, South San Francisco, CA, 94080, USA

    C. D. O’Malley

  2. Amgen Inc., One Amgen Center Drive, Thousand Oaks, CA, 91320, USA

    N. Tran, C. Zapalowski & N. Daizadeh

  3. Department of Rheumatology, Geisinger Medical Center, 100 North Academy Avenue, Danville, PA, 17822, USA

    T. P. Olenginski

  4. Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, 130 De Soto Street, Pittsburgh, PA, 15261, USA

    J. A. Cauley

Authors
  1. C. D. O’Malley
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  2. N. Tran
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  3. C. Zapalowski
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  4. N. Daizadeh
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  5. T. P. Olenginski
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  6. J. A. Cauley
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Corresponding author

Correspondence to C. D. O’Malley.

Appendices

Appendices

Appendix 1

Table 5 List of ICD-9- CM codes used to define osteoporotic fractures
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Appendix 2

Table 6 List of conditions investigated in women with and without osteoporosis (N = 22,414 for each cohort)
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O’Malley, C.D., Tran, N., Zapalowski, C. et al. Multimorbidity in women with and without osteoporosis: results from a large US retrospective cohort study 2004–2009. Osteoporos Int 25, 2117–2130 (2014). https://doi.org/10.1007/s00198-014-2740-3

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  • DOI: https://doi.org/10.1007/s00198-014-2740-3

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