Herpes zoster associated with fragility fractures in older U.S. veterans
A matched cohort study found that patients with a previous diagnosis of herpes zoster had a 15% higher risk for incident fragility fracture than those without.
Older patients with a diagnosis of herpes zoster may be at higher risk for incident fragility fractures than those without, a recent study found.
To evaluate whether herpes zoster affects long-term bone health, researchers used data from the Veterans Aging Cohort Study to compare risk for fragility fractures between patients with a previous diagnosis of herpes zoster and those without. Veterans who were older than age 40 years and had incident diagnoses of herpes zoster, defined as ICD-9 or ICD-10 codes for at least one inpatient or outpatient diagnosis of herpes zoster or acute herpes zoster complications, were matched with up to five veterans without previous documentation of herpes zoster infection. Fractures were assessed by site (hip/femoral, shoulder/upper arm, vertebral, and wrist/forearm) and overall using a Cox model that adjusted for sociodemographic, lifestyle, and clinical confounders. The study results were published Oct. 17 by the Journal of the American Geriatrics Society.
For the study period of Jan. 1, 2008, to Dec. 31, 2023, a total of 229,992 patients with a history of herpes zoster diagnosis were matched to 1,134,519 without. Median age (67.8 years vs. 67.7 years), percentage of men (93.5% vs. 93.7%), and median follow-up time (5.9 years vs. 5.4 years) were similar between groups. During follow-up, incident fragility fractures occurred in 10,499 patients with a herpes zoster diagnosis and 33,932 without. Risk for incident fragility fracture was 15% higher in the herpes zoster group (adjusted hazard ratio [HR], 1.15; 95% CI, 1.13 to 1.18), with increased risk seen at each fracture site (adjusted HRs, 1.18 [95% CI, 1.14 to 1.22] for vertebral, 1.17 [95% CI, 1.12 to 1.22] for wrist/forearm, 1.15 [95% CI, 1.09 to 1.22] for shoulder/upper arm, and 1.08 [95% CI, 1.02 to 1.14] for hip/femoral). Those who were older, frailer, and had received antiviral treatment for herpes zoster within seven days of diagnosis were at higher fracture risk.
Limitations include that most of the study participants were men and that patients with mild herpes zoster may not seek out health care and therefore these cases may not be recorded, the authors noted. They concluded that herpes zoster appears to be associated with risk for fragility fractures in older adults and that health care professionals should promote the uptake of the recombinant shingles vaccine to reduce herpes zoster-related complications.
“Our findings underscore fragility fractures as a public health concern among male Veterans, a group not typically considered high risk,” they wrote. “Future studies should address non-Veteran and female populations.”