Incidence of chronic osteomyelitis between 2016 and 2022 in a large, multicenter database in the United States

Introduction: Chronic osteomyelitis (COM) is a serious musculoskeletal infection that affects a patient's quality of life and long-term survival. In this study, we assessed overall, regional, and patient-level characteristics of bacterial COM in a large, multicenter database in the United States. Methods: We used ICD-10 codes to identify incident bacterial COM in the TriNetX database between 1 January 2016 and 31 December 2022. We calculated COM incidence per 1000 adult patients with the associated 95 % confidence intervals. We used the Cochran-Armitage test to assess incidence trends across the study period. Results: A total of 93 324 adult patients were identified. Overall, a steady COM incidence was observed over time, with some indication of lower rates starting in 2020. The incidence was about 2-fold higher in males than females. As expected, lower-extremity COM was most common overall and among males. Although lower-extremity COM and vertebral COM had comparable incidence among females, vertebral COM became slightly more common than lower-extremity COM among females during the study period. Conclusions: To our knowledge, this study provides the largest available, multicenter estimate of COM incidence in the United States. Although the incidence of COM was generally steady over time, a slight reduction was noted during the pandemic (2020 and later). This finding may reflect important differences in ascertainment or competing risks during that period.