Osteomyelitis and Osteomyelitis-Related Amputations in Texas Diabetic Populations

Background: Osteomyelitis (OM) is a complex bone disease most often caused by microorganism-based infections; it poses significant challenges for diagnosis and treatment. Previous epidemiologic studies have identified upward temporal trends in the diagnosis of OM. This study examined these trends in diabetic OM and OM-related amputations in Texas, a state with one of the highest rates of diabetes in the United States. Methods: Retrospective analysis was conducted on Texas diabetic inpatient hospital data from 2006 to 2016. Data were extracted for patients who had diagnostic codes for diabetes and for foot and ankle OM, along with data for OM-related major or minor amputations. Rates were calculated per 1,000 people and standardized using 2019 population estimates. Results: The prevalence of diabetic OM increased from 2006 to 2016, as did total, major, and minor amputations in patients with OM. Decreases were noted in 2014 to 2016. Age-standardized rates demonstrated the same trends, as did rates across all of the age groups. Osteomyelitis increased most in 45-to 64-year-olds. Amputation rates increased similarly in 45-to 64-year-olds, 65-to 74-year-olds, and those 75 years and older. Poisson regression analysis reinforced these trends, with significant increases in risk ratios for OM and amputation rates in all of the age groups. Conclusions: This preliminary analysis highlights the increasing prevalence of OM and OM-related amputations in diabetic patients from 2006 to 2016 and for all age groups (18– 75 years and older) in Texas. Although increasing diabetes rates may contribute to the observed trends in OM, it does not exclusively explain them. Further research should investigate possible interventions to mitigate the rise in diabetic OM and associated amputations.