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People with atopic eczema at risk of broken bones

Published online: November 19, 2019

Atopic eczema (sometimes called atopic dermatitis) is a common skin condition, affecting 1 in 5 children and up to 1 in 10 adults, associated with intensely itchy red skin. Broken bones (fractures) are associated with increased illness and death. Given how many people have eczema, and the health and cost implications of broken bones, any link could have a big impact on public health. There is some existing research that has shown links between atopic eczema and osteoporosis (a condition that weakens bones and makes them more likely to break), and between atopic eczema and fracture. However, the existing research hasn’t been able to answer questions about whether the eczema precedes fractures or vice versa. And previous studies have also not been able to assess whether fracture risk increases with increasing eczema severity.

In an article recently published in The Journal of Allergy and Clinical Immunology (JACI), Lowe, Mansfield and colleagues used large numbers of routinely collected electronic medical records from English primary care consultations and hospital admissions. The study followed over half-a-million adults with atopic eczema and over two and a half million without eczema over time to see if they had any broken bones (the study authors specifically focussed on fractures that have been associated with osteoporosis).

The study found that risk of any broken bone was up to 13% greater in people with atopic eczema compared to people without, and increased with increasing eczema severity. The increased risk of fracture in people with atopic eczema persisted even after accounting for oral corticosteroids (these are drugs that are sometimes used to treat eczema that are known to be linked to increased fracture risk). People with severe atopic eczema had a dramatically increased risk of fracture: 50% more hip fractures, 66% more pelvis fractures, and over double the risk of spine fracture. The study estimated that, in 100,000 people with eczema, an extra 164 people would break a bone compared to the number of broken bones that would be expected in a group of 100,000 people without eczema.

The study shows that atopic eczema is associated with an increased risk of fractures. The substantial increase in the risk of spine, hip and pelvic fractures seen in people with severe atopic eczema is particularly concerning given the high risk of illness and death associated with these fractures. The authors’ findings suggest that people with severe atopic eczema may benefit from targeted testing of bone density to help prevent fractures, improve long-term quality of life, and reduce fracture-related healthcare costs.

The Journal of Allergy and Clinical Immunology (JACI) is an official scientific journal of the AAAAI, and is the most-cited journal in the field of allergy and clinical immunology.

Graphical Abstract