Fracture risks in patients aged 50 years and older with panhypopituitarism: a nationwide cohort study

This study investigated fracture risks in 3,877 older adults with panhypopituitarism compared with matched controls using Korean health insurance data. Findings showed higher risks of major osteoporotic, spine, and hip fractures in both men and women with panhypopituitarism compared to controls, with a more pronounced increase in risk among men.

Patients with hypopituitarism are known to have increased cardiovascular risk and mortality; however, data on fracture risk are limited. We aimed to identify gender- and site-specific fracture risks and factors associated with fractures in patients aged ≥ 50 years with panhypopituitarism, compared with age-, sex-, and index year-matched controls.

Using the Korea National Health Insurance Service (NHIS) Database, we identified 3,877 patients with panhypopituitarism aged ≥ 50 years and 1:10 age-, sex-, and index year-matched controls. Demographics comorbidities, and fracture outcomes, including major osteoporotic fractures (MOFs), vertebral fractures (VFs), non-vertebral fractures (non-VFs), and hip fractures (HFs), were obtained using the International Classification of Disease-10 codes and hospital records.

The mean ages of male and female panhypopituitary patients were 63.5 and 63.6 years, respectively. Male patients exhibited a significantly elevated risk of MOFs (hazard ratio [HR] = 2.16, 95% confidence interval [CI] = 1.87-2.48), VFs (HR = 2.13, 95% CI = 1.80-2.51), non-VFs (HR = 2.41, 95% CI = 1.94-3.00), and HFs (HR = 2.28, 95% CI = 1.59-3.27) compared to controls (all P < 0.001). Similarly, female patients demonstrated a significantly increased risk of MOFs (HR = 1.29, 95% CI = 1.16-1.42), VFs (HR = 1.45, 95% CI = 1.29-1.63), and HFs (HR = 1.68, 95% CI = 1.26-2.24) compared to controls (all P < 0.001), but not non-VFs. In addition to known risk factors like age, female sex, and fracture history, cerebrovascular disease, dementia, and low income were also associated with higher MOFs.

Patients with panhypopituitarism, particularly males, have a higher risk of fracture than matched controls. Comorbidities such as dementia and cerebrovascular disease may further increase the risk of fractures.