Increased risk of hip and wrist fracture in patients with cirrhosis compared with the general population

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Increased risk of hip and wrist fracture in patients with cirrhosis compared with the general population: a population-based cohort study

Joe West1, Zahid Asghar1, Guruprasad P. Aithal2, Tim R. Card1, 3, Kate Fleming11. Division of Epidemiology and Public Health, University of Nottingham, Nottingham, United Kingdom. 2. Nottingham Digestive Diseases Centre, Biomedical Research Unit, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom. 3. Department of Gastroenterology, Kings Mill Hospital, Sutton, Ashfield, United Kingdom.


OBJECTIVES:

While numerous studies have shown an association between chronic liver disease and osteoporosis few have documented accurately the risks of osteoporotic fracture in these patients and none have compared incidence rates to the general population. We have therefore performed a cohort study using the General Practice Research Database (GPRD) to quantify the excess fracture risk in people with cirrhosis.

AIMS & METHODS:

We obtained all records of patients with a diagnostic of therapeutic code for cirrhosis, oesophageal varices and/or portal hypertension within the
General Practice Research Database=GPRD between June 1987 and April 2002 and records of up to 10 age-, sex- and practice matched controls.
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We examined hazard ratios of hip and wrist fracture rates for patients with cirrhosis versus general population controls using cox proportional hazards, adjusted for age at entry to the study and sex. Analyses were stratified by aetiology of cirrhosis and severity of disease.

RESULTS:
Patients with cirrhosis had a higher hazard of hip and wrist fracture
*see table 1
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Patients with alcoholic cirrhosis had a higher hazard ratio for fractures than patients with non-alcoholic related cirrhosis.
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However, this is mediated by increased risk of fracture in older control population on non-alcoholic related cirrhosis
*see table 2
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A total of 4787 subjects with cirrhosis and 46,789 appropriately matched controls contributing 205,852 person years of follow-up were included within our analysis.
Main results are displayed in the table below.
There was a 4-fold increased hazard of hip fracture and nearly 2-fold increased hazard of colles fracture for the cirrhosis cohort compared with the general population.


Rates were higher for patients with decompensated disease than those with compensated cirrhosis. Absolute fracture rates in patients with alcoholic cirrhosis and non-alcohol related cirrhosis were very similar at 5.2 and 5.1 per 1000 person years respectively.


The difference in hazard ratios can be largely attributed to the older age of the patients with non-alcohol related cirrhosis and therefore the higher risk of fracture in their control population.
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CONCLUSION:

There are large relative increases in fracture risks in people with cirrhosis compared with the general population.
The absolute excess rates we have observed mean that consideration should be given to interventions in this group to reduce fracture risk.
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Abstract # 1180. AASLD 2010
http://trs.scivee.tv/node/2691
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