P078 Frailty and fracture risk in patients with bullous pemphigoid receiving systemic corticosteroids: a retrospective cohort study

Abstract

Bullous pemphigoid (BP) predominantly affects older adults and requires systemic corticosteroids. However, older patients often present with frailty, inflammatory malnutrition and osteoporotic fracture risk, which may influence disease course and outcomes. The aim of this study was to evaluate the relationships between frailty, malnutrition and fracture risk, and systemic steroid burden, severity and clinical outcomes in BP. This retrospective cohort study included patients with BP aged ≥ 65 years (n = 90). Frailty was assessed using the modified Frailty Index-5 (mFI-5), inflammatory malnutrition using the modified Glasgow Prognostic Score (mGPS) and 10-year major osteoporotic fracture risk using FRAX. Disease severity was categorized by Bullous Pemphigoid Disease Area Index (BPDAI) (stratified as 0–20, 21–57, ≥ 58). Steroid exposure and clinical outcomes were extracted from medical records. The median age of the cohort was 73.0 years (interquartile range 66.0–80.5), and 65 patients (72%) were female. Osteoporotic fractures occurred in 6 patients (7%). In multivariable Firth regression models, fracture risk was independently associated with higher inflammatory burden [mGPS 1–2 vs. 0; odds ratio (OR) 4.21, 95% confidence interval (CI) 1.12–15.9; P = 0.03], prior fracture history (OR 5.47, 95% CI 1.18–25.4; P = 0.03), greater disease severity (OR 1.29 per 10-point BPDAI increase, 95% CI 1.01–1.66; P = 0.04), combined initial therapy compared with systemic therapy alone (OR 6.48, 95% CI 1.52–27.5; P = 0.01), higher baseline corticosteroid dose (OR 1.32 per 10 mg, 95% CI 1.03–1.69; P = 0.03), longer hospital stay (OR 1.02 per day, 95% CI 1.00–1.05; P = 0.04) and a history of falls (OR 6.64, 95% CI 2.84–18.4; P < 0.001). Osteoporosis treatment was associated with significantly lower odds of fracture (OR 0.19, 95% CI 0.03–0.96; P = 0.045). In older patients with BP, osteoporotic fractures are independently associated with inflammatory burden, disease severity, fall risk and cumulative corticosteroid exposure, while osteoporosis treatment appears protective. Incorporating inflammation-informed risk stratification with proactive osteoporosis management and fall-prevention strategies may help reduce fracture risk in this vulnerable population.