Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Jun 8:49:101488.
doi: 10.1016/j.eclinm.2022.101488. eCollection 2022 Jul.

Osteoporosis is a novel risk factor of infections and sepsis: A cohort study

Xiaowen Zhang  1 , Kwong-Wai Man  1 , Gloria Hoi-Yee Li  2 , Kathryn Cb Tan  3 , Annie Wai-Chee Kung  3 , Ching-Lung Cheung  1
Affiliations

Osteoporosis is a novel risk factor of infections and sepsis: A cohort study

Xiaowen Zhang et al. EClinicalMedicine. .

Abstract

Background: Accumulating evidence suggests the interaction of bone metabolism and the immune system, but how bone health is associated with the risk of infections remains unknown.

Methods: This study aimed to investigate the relationship of bone mineral density (BMD) with the risk of common infections and sepsis in Hong Kong Osteoporosis Study (HKOS). A prospective cohort study, initiated in 1995 and followed until 31 December 2020, of 5,717 participants examined the association of BMD at three skeletal sites (lumbar spine, femoral neck, and total hip) with common infections - pneumonia, urinary tract infection (UTI), skin infection, and sepsis. Cox proportional hazards models were used to estimate hazard ratios (HR) and 95% confidence intervals (CI).

Findings: During the median follow-up of 17 years, higher BMD T-scores at the femoral neck and total hip were significantly associated with the reduced risk of pneumonia (HRs 0.89 and 0.87; 95% CIs 0.82 to 0.98 and 0.81 to 0.95), UTI (HRs 0.85 and 0.86; 95% CIs 0.76 to 0.94 and 0.78 to 0.95), skin infection (HRs 0.85 and 0.82; 95% CIs 0.74 to 0.97 and 0.73 to 0.93), and sepsis (HRs 0.83 and 0.82; 95% CIs 0.71 to 0.97 and 0.72 to 0.94). A significant association was observed for the lumbar spine BMD T-score with the risk of skin infection (HR 0.86; 95% CI: 0.78 to 0.95) but not with other infections and sepsis. Similarly, participants with osteoporosis, but not osteopenia, were significantly associated with an increased risk of infections and sepsis compared to those with normal BMD.

Interpretation: BMD is a novel risk factor of infections and sepsis. People with low BMD, particularly those with osteoporosis, are at higher risk of infections and sepsis than those with normal BMD. Further studies on whether improving bone health can reduce the risk of infections and sepsis are warranted.

Funding: None.

Keywords: Immunology; Infections; Osteoimmunology; Osteoporosis; Sepsis.

PubMed Disclaimer

Conflict of interest statement

Dr. Cheung reports grants and personal fees from Amgen, outside the submitted work. The other authors have nothing to declare.

Figures

Figure 1
Figure 1
Selection of cohort.
Figure 2
Figure 2
Kaplan–Meier (K-M) cumulative survival curves for the incidence of (a) pneumonia, (b) UTI, (c) skin infection, and (d) sepsis depending on BMD T-score groups. The number at risk and number censored were shown below the survival curves. Log-rank tests indicated a statistically significant difference in survival in all analyses (P<0.0001). (a). K-M cumulative survival curves for the incidence of pneumonia. (b). K-M cumulative survival curves for the incidence of UTI. (c). K-M cumulative survival curves for the incidence of skin infection. (d). K-M cumulative survival curves for the incidence of sepsis.
Figure 2
Figure 2
Kaplan–Meier (K-M) cumulative survival curves for the incidence of (a) pneumonia, (b) UTI, (c) skin infection, and (d) sepsis depending on BMD T-score groups. The number at risk and number censored were shown below the survival curves. Log-rank tests indicated a statistically significant difference in survival in all analyses (P<0.0001). (a). K-M cumulative survival curves for the incidence of pneumonia. (b). K-M cumulative survival curves for the incidence of UTI. (c). K-M cumulative survival curves for the incidence of skin infection. (d). K-M cumulative survival curves for the incidence of sepsis.
See this image and copyright information in PMC

References

    1. Global Health Estimates 2020 . World Health Organization; 2020. Deaths by Cause, Age, Sex, by Country and by Region, 2000-2019.https://www.who.int/data/gho/data/themes/mortality-and-global-health-est... Available from: Accessed 10th September 2021.
    1. World Health Organization; Geneva: 2020. Global report on the epidemiology and burden of sepsis: current evidence, identifying gaps and future directions.
    1. WHO calls for global action on sepsis - cause of 1 in 5 deaths worldwide 2020. Available from:https://www.who.int/news/item/08-09-2020-who-calls-for-global-action-on-.... Accessed 20 September 2021
    1. Terashima A, Takayanagi H. The role of bone cells in immune regulation during the course of infection. Semin Immunopathol. 2019;41(5):619–626. - PubMed
    1. Terashima A, Okamoto K, Nakashima T, Akira S, Ikuta K, Takayanagi H. Sepsis-Induced Osteoblast Ablation Causes Immunodeficiency. Immunity. 2016;44(6):1434–1443. - PubMed

LinkOut - more resources