Bullous Pemphigoid Patients Face Higher Risk of Osteoporosis and Hip Fractures: Study Suggests
Israel: A new population-based study published in Archives of Dermatological Research reveals that individuals with bullous pemphigoid (BP) face a significantly increased risk of bone-related complications, including osteoporosis and femoral head fractures (FHF). The research, led by Dr. Khalaf Kridin from the Unit of Dermatology and Skin Research Laboratory, Galilee Medical Center, Israel, highlights the need for vigilant bone health management in this vulnerable group.
BP, an autoimmune blistering disorder primarily affecting older adults, has been associated with systemic complications in recent years. However, its potential link to skeletal health has remained poorly understood. This study aimed to quantify the risk of osteoporosis and FHF among BP patients and assess the influence of treatment regimens on these outcomes.
The retrospective cohort analysis utilized data from Clalit Health Services, Israel’s largest healthcare database, including 3,924 newly diagnosed BP patients and 19,280 matched controls. Researchers estimated incidence rates and hazard ratios (HRs) for osteoporosis and FHF using multivariate Cox regression, adjusting for demographic and clinical factors. The impact of different therapeutic strategies—systemic corticosteroids (SCS), topical corticosteroids (TCS), and adjuvant immunosuppressants—was also evaluated.
The key findings of the study were as follows:
- BP patients had a 66% higher risk of osteoporosis compared to controls (adjusted HR 1.66).
- BP patients faced a 23% increased risk of femoral head fractures (adjusted HR 1.23).
- Systemic corticosteroids significantly raised osteoporosis risk compared to topical therapy (HR 1.59).
- A combination of systemic corticosteroids with immunosuppressants further amplified osteoporosis risk, while systemic corticosteroid monotherapy showed a lower risk (HR 0.38).
- Treatment type did not significantly impact femoral head fracture incidence.
- Femoral head fractures were associated with a 42% higher mortality risk (HR 1.42).
“These findings indicate that BP is an independent risk factor for osteoporosis and femoral head fractures,” the authors noted. The strong association with systemic corticosteroid use suggests a need for cautious prescribing and proactive preventive measures, such as bone density monitoring and fracture risk assessment. Strategies like calcium and vitamin D supplementation, bisphosphonate therapy, and lifestyle interventions could play a crucial role in reducing the burden of skeletal complications in BP patients.
Given the aging population and the growing prevalence of BP, this study highlights the importance of integrating bone health surveillance into the routine care of patients, especially those undergoing systemic corticosteroid therapy.
"These results emphasize the importance of active bone health monitoring and implementing fracture prevention strategies in BP patients, especially those receiving systemic corticosteroid therapy," the authors concluded.
Reference:
Kaplan, B., Abu-Khalil, M., Kaykov, E. et al. Bone-related outcomes in patients with bullous pemphigoid: a population-based study. Arch Dermatol Res 317, 846 (2025). https://doi.org/10.1007/s00403-025-04347-z
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