Associations of allergic diseases with incident hospital-recorded osteoporosis and major osteoporotic fracture in older adults: a prospective cohort study in the UK Biobank.

BACKGROUND

Osteoporosis and fragility fractures are major causes of disability and loss of independence in older adults. Prospective evidence on the associations between allergic diseases and these outcomes in older populations remains limited, particularly regarding coexistence patterns and allergic disease burden. This study therefore evaluated these associations in a large prospective cohort of older adults.

METHODS

UK Biobank participants aged 60 years or older and free of the corresponding outcome at baseline were included. Baseline allergic rhinitis, atopic dermatitis, and asthma were identified from inpatient records and self-report and were further summarised as coexistence patterns and allergic disease burden. Associations with incident major osteoporotic fracture and hospital-recorded osteoporosis, ascertained from linked inpatient hospital records, were evaluated using multivariable Cox proportional hazards models adjusted for sociodemographic, lifestyle, psychosocial, and comorbidity factors. Robustness was assessed through multiple prespecified sensitivity analyses.

RESULTS

Over a median follow-up of 13.8 years, 11,442 major osteoporotic fracture events and 12,096 cases of hospital-recorded osteoporosis occurred among 190,594 and 191,881 participants, respectively. In fully adjusted models, asthma was associated with major osteoporotic fracture (hazard ratio 1.20, 95% confidence interval 1.14-1.27) and hospital-recorded osteoporosis (1.45, 1.38-1.52). The coexistence of allergic rhinitis and asthma was also associated with both outcomes (major osteoporotic fracture: 1.36, 1.16-1.59; hospital-recorded osteoporosis: 1.46, 1.26-1.69). In addition, allergic disease burden showed a graded association with both outcomes. Findings were broadly consistent across sensitivity analyses.

CONCLUSIONS

In older adults, asthma, particularly when coexisting with allergic rhinitis, and greater allergic disease burden were associated with incident hospital-recorded osteoporosis and major osteoporotic fracture. These observational findings should be interpreted cautiously and require confirmation in further studies.