Hospital-Treated Infections and 15-year Incidence of Musculoskeletal Disorders: A Large Population-Based Cohort Study.

Summary

In 502,409 UK Biobank participants, prior hospital-treated infections were associated with higher risks of six musculoskeletal disorders, strongest for osteoporosis (HR 1.55) and rheumatoid arthritis (HR 1.53). Associations were similar for bacterial and viral infections, strengthened with more frequent/severe infections, and persisted beyond 10 years.

Key Findings

• Prior hospital-treated infections increased risks of all six MSK disorders; strongest associations for osteoporosis (HR 1.55) and rheumatoid arthritis (HR 1.53).
• Risks were similar across bacterial and viral infections and were higher with more frequent/severe infections, suggesting a systemic effect.
• Associations persisted even when excluding incident cases within the first 5 and 10 years post-baseline, indicating long-term risk.

Clinical Implications

Patients with a history of hospital-treated infections may benefit from long-term MSK health monitoring, including bone health assessment and early rheumatologic evaluation, especially when infections are frequent or severe.

Limitations

• Residual confounding and misclassification of infection severity/pathogens are possible in observational data.
• Generalizability beyond the UK Biobank population may be limited; outpatient-treated infections were not the primary exposure.

Future Directions

Mechanistic studies to elucidate immune-bone crosstalk post-infection and intervention trials testing bone/rheumatic surveillance and prevention strategies in high-risk post-infection populations.