Objectives. This study aimed to establish the prevalence of multimorbidity in women diagnosed with osteoporosis and to report it by deprivation index. The characteristics of comorbidity in osteoporotic women are compared to the general female chronic population, and the impact on healthcare expenditure of this population group is estimated. Methods. A cross-sectional analysis that included all Basque Country women aged 45 years and over ( = 579,575) was performed. Sociodemographic, diagnostic, and healthcare cost data were extracted from electronic databases for a one-year period. Chronic conditions were identified from their diagnoses and prescriptions. The existence of two or more chronic diseases out of a list of 47 was defined as multimorbidity. Results. 9.12% of women presented osteoporosis and 85.04% of them were multimorbid. Although multimorbidity in osteoporosis increased with age and deprivation level, prevalence was higher in the better-off groups. Women with osteoporosis had greater risk of having other musculoskeletal disorders but less risk of having diabetes (RR = 0.65) than chronic patients without osteoporosis. People with poorer socioeconomic status had higher healthcare cost. Conclusions. Most women with osteoporosis have multimorbidity. The variety of conditions emphasises the complexity of clinical management in this group and the importance of maintaining a generalist and multidisciplinary approach to their clinical care. 1. Background Multimorbidity, defined as two or more coexisting chronic conditions within an individual [1], is a growing phenomenon in ageing societies and is especially prevalent in older age groups [2–4]. Multimorbidity makes management of chronic conditions by clinicians more complex; they often lack evidence on the best care strategies to follow with this type of patient. In fact, clinical guidelines rarely address multimorbidity and clinical trials often exclude comorbid and older patients [5, 6]. Individuals manifesting multimorbidity are typically associated with higher degrees of disability, lower quality of life, greater psychological distress and mortality risk [7–9], and increased use of health (and social) care [10, 11] services than if we considered these chronic conditions in isolation or individuals with a single chronic condition. It is of particular relevance for patients, their carers, and healthcare providers, but increasingly a concern for policy makers and societies as a whole [7]. Therefore, it is widely accepted that health systems need to focus their strategies in organising healthcare
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