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Research findings on fracture risk in adults with eczema

Professor Sinéad Langan and the team from the London School of Hygiene & Tropical Medicine, which authored the study on the link between atopic eczema and fracture risk in adults, write:

 

You may have seen media reports with some rather scary headlines. In the paper, we reported that adults with eczema could have an increased risk of the type of broken bones that tend to be related with a condition called osteoporosis (a condition that weakens bones increasing fracture risk). Our findings were based on a study of GP and hospital records for large numbers of people with eczema (approximately 400,000).

So, if you have eczema, what do the results mean for you? We have summarised the key points below:

The overall risk of a broken bone is very low, so even though we have shown an increase, this still represents a low risk of fractures (as a 10% increase of a small amount of risk is still a small amount of risk).

Our study estimated that an extra 164 people would break a bone compared to the number of bones expected in a group of 100,000 people without eczema.

NICE (an organisation that guides the NHS about which treatments work and what tests should be done) guidance already highlights a lot of the issues we raised in our article, and NHS patients will be managed accordingly.

NICE guides GPs and other doctors on what they should do about assessing fracture risk. The full guidelines are available here, www.nice.org.uk/guidance/cg146/evidence/full-guideline-pdf-186818365. Briefly, NICE recommends that doctors should consider assessing fracture risk in women over 65 and men over 75. In younger people, NICE recommends that doctors should consider carrying out assessments in specific groups of people. These groups include people on long-term oral steroids. When patients with these risk factors attend GP appointments, GPs assess risk of fracture using questionnaires and checklists that have been proven to be useful for this purpose (including tools such as FRAX or QFracture). These fracture-risk assessment tools guide GPs in determining who needs a bone scan and who needs preventive treatment.

• People who have taken higher doses of oral steroids for long periods are an important group for whom doctors should consider assessing fracture risk.

However, increasing recognition of the risk of steroid treatment means that few people now use long-term high-dose steroid tablets for treating eczema, and it would be very rare indeed in the modern treatment of eczema.

In our study, we did not look directly at the effect of the drugs used to treat eczema. It may be that the increase in bone breaks that we saw was a consequence of eczema, rather than a side effect of treatments.

There are still questions to be addressed by future research to understand the reasons for the increased fracture risk identified in our study and whether additional bone-density screening is warranted in those with eczema, beyond the NICE recommendations above, and to further understand what we can do to improve bone health for people with eczema. 

For more information: www.lshtm.ac.uk/newsevents/news/2019/atopic-eczema-linked-increased-fracture-risk-adults

Research findings on fracture risk in adults wi...