The Risk of Fractures Among Patients With Cirrhosis or Chronic Pancreatitis

Ulrich Christian Bang; Thomas Benfield; Flemming Bendtsen; Lars Hyldstrup; Jens-Erik Beck Jensen

doi:10.1016/j.cgh.2013.04.031

The Risk of Fractures Among Patients With Cirrhosis or Chronic Pancreatitis

Ulrich Christian Bang, Thomas Benfield, Flemming Bendtsen, Lars Hyldstrup, Jens-Erik Beck Jensen

34 Citations (Scopus)

Abstract

Background & Aims: Cirrhosis and chronic pancreatitis (CP) are accompanied by inflammation and malnutrition. Both conditions can have negative effects on bone metabolism and promote fractures. We evaluated the risk of fractures among patients with CP or cirrhosis and determined the effect of fat malabsorption on fracture risk among patients with CP. Methods: We performed a retrospective cohort study using the Danish National Patient Register to identify patients diagnosed with CP or cirrhosis. We analyzed data collected from January 1, 1995, to December 31, 2010, on 20,769 patients (35.5% women with cirrhosis and 11,972 patients (33.5% women) with CP. Each patient was compared with 10 age- and sex-matched controls. We also assessed the risk of fractures among patients with CP who received pancreatic enzyme substitution (PES) for fat malabsorption. Results: During the study period, bone fractures occurred in 3954 patients with cirrhosis and 2594 patients with CP. The adjusted hazard ratio (HR) for any fracture was 2.4 in patients with cirrhosis (95% confidence interval [CI], 2.2-2.5) and 1.7 in patients with CP (95% CI, 1.6-1.8). The relative risk of low-trauma fractures was highest among individuals younger than 50 years old. Alcohol as an etiology was associated with an increased risk of fracture compared with patients with nonalcoholic cirrhosis (HR, 2.4 vs 1.5; P < .0001) and CP (HR, 2.0 vs 1.5; P < .0001). Patients with CP receiving PES for fat malabsorption had a lower risk of fractures than other CP patients (HR, 0.8; 95% CI, 0.7-0.9). However, increasing the duration of treatment with PES was associated with an increased risk of fracture. Conclusions: Patients, especially younger patients, with cirrhosis or CP have an increased risk of fractures of all types.

Original language	English
Journal	Clinical Gastroenterology and Hepatology
Volume	12
Issue number	2
Pages (from-to)	320-326
Number of pages	7
ISSN	1542-3565
DOIs	https://doi.org/10.1016/j.cgh.2013.04.031
Publication status	Published - Feb 2014

Keywords

Adult
Age Factors
Alcohol Drinking
Comorbidity
Dietary Fats
Female
Femoral Fractures
Forearm Injuries
Fractures, Bone
Humans
Leg Injuries
Liver Cirrhosis
Malabsorption Syndromes
Male
Middle Aged
Pancreatitis, Chronic
Retrospective Studies
Risk Assessment

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1016/j.cgh.2013.04.031

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@article{c21af0b2b9c74bf6a2caa61192d8b57f,

title = "The Risk of Fractures Among Patients With Cirrhosis or Chronic Pancreatitis",

abstract = "Background & Aims: Cirrhosis and chronic pancreatitis (CP) are accompanied by inflammation and malnutrition. Both conditions can have negative effects on bone metabolism and promote fractures. We evaluated the risk of fractures among patients with CP or cirrhosis and determined the effect of fat malabsorption on fracture risk among patients with CP. Methods: We performed a retrospective cohort study using the Danish National Patient Register to identify patients diagnosed with CP or cirrhosis. We analyzed data collected from January 1, 1995, to December 31, 2010, on 20,769 patients (35.5% women with cirrhosis and 11,972 patients (33.5% women) with CP. Each patient was compared with 10 age- and sex-matched controls. We also assessed the risk of fractures among patients with CP who received pancreatic enzyme substitution (PES) for fat malabsorption. Results: During the study period, bone fractures occurred in 3954 patients with cirrhosis and 2594 patients with CP. The adjusted hazard ratio (HR) for any fracture was 2.4 in patients with cirrhosis (95% confidence interval [CI], 2.2-2.5) and 1.7 in patients with CP (95% CI, 1.6-1.8). The relative risk of low-trauma fractures was highest among individuals younger than 50 years old. Alcohol as an etiology was associated with an increased risk of fracture compared with patients with nonalcoholic cirrhosis (HR, 2.4 vs 1.5; P < .0001) and CP (HR, 2.0 vs 1.5; P < .0001). Patients with CP receiving PES for fat malabsorption had a lower risk of fractures than other CP patients (HR, 0.8; 95% CI, 0.7-0.9). However, increasing the duration of treatment with PES was associated with an increased risk of fracture. Conclusions: Patients, especially younger patients, with cirrhosis or CP have an increased risk of fractures of all types.",

keywords = "Adult, Age Factors, Alcohol Drinking, Comorbidity, Dietary Fats, Female, Femoral Fractures, Forearm Injuries, Fractures, Bone, Humans, Leg Injuries, Liver Cirrhosis, Malabsorption Syndromes, Male, Middle Aged, Pancreatitis, Chronic, Retrospective Studies, Risk Assessment",

author = "Bang, {Ulrich Christian} and Thomas Benfield and Flemming Bendtsen and Lars Hyldstrup and {Beck Jensen}, Jens-Erik",

year = "2014",

month = feb,

doi = "10.1016/j.cgh.2013.04.031",

language = "English",

volume = "12",

pages = "320--326",

journal = "Clinical Gastroenterology and Hepatology",

issn = "1542-3565",

publisher = "W.B.Saunders Co.",

number = "2",

}

TY - JOUR

T1 - The Risk of Fractures Among Patients With Cirrhosis or Chronic Pancreatitis

AU - Bang, Ulrich Christian

AU - Benfield, Thomas

AU - Bendtsen, Flemming

AU - Hyldstrup, Lars

AU - Beck Jensen, Jens-Erik

PY - 2014/2

Y1 - 2014/2

N2 - Background & Aims: Cirrhosis and chronic pancreatitis (CP) are accompanied by inflammation and malnutrition. Both conditions can have negative effects on bone metabolism and promote fractures. We evaluated the risk of fractures among patients with CP or cirrhosis and determined the effect of fat malabsorption on fracture risk among patients with CP. Methods: We performed a retrospective cohort study using the Danish National Patient Register to identify patients diagnosed with CP or cirrhosis. We analyzed data collected from January 1, 1995, to December 31, 2010, on 20,769 patients (35.5% women with cirrhosis and 11,972 patients (33.5% women) with CP. Each patient was compared with 10 age- and sex-matched controls. We also assessed the risk of fractures among patients with CP who received pancreatic enzyme substitution (PES) for fat malabsorption. Results: During the study period, bone fractures occurred in 3954 patients with cirrhosis and 2594 patients with CP. The adjusted hazard ratio (HR) for any fracture was 2.4 in patients with cirrhosis (95% confidence interval [CI], 2.2-2.5) and 1.7 in patients with CP (95% CI, 1.6-1.8). The relative risk of low-trauma fractures was highest among individuals younger than 50 years old. Alcohol as an etiology was associated with an increased risk of fracture compared with patients with nonalcoholic cirrhosis (HR, 2.4 vs 1.5; P < .0001) and CP (HR, 2.0 vs 1.5; P < .0001). Patients with CP receiving PES for fat malabsorption had a lower risk of fractures than other CP patients (HR, 0.8; 95% CI, 0.7-0.9). However, increasing the duration of treatment with PES was associated with an increased risk of fracture. Conclusions: Patients, especially younger patients, with cirrhosis or CP have an increased risk of fractures of all types.

AB - Background & Aims: Cirrhosis and chronic pancreatitis (CP) are accompanied by inflammation and malnutrition. Both conditions can have negative effects on bone metabolism and promote fractures. We evaluated the risk of fractures among patients with CP or cirrhosis and determined the effect of fat malabsorption on fracture risk among patients with CP. Methods: We performed a retrospective cohort study using the Danish National Patient Register to identify patients diagnosed with CP or cirrhosis. We analyzed data collected from January 1, 1995, to December 31, 2010, on 20,769 patients (35.5% women with cirrhosis and 11,972 patients (33.5% women) with CP. Each patient was compared with 10 age- and sex-matched controls. We also assessed the risk of fractures among patients with CP who received pancreatic enzyme substitution (PES) for fat malabsorption. Results: During the study period, bone fractures occurred in 3954 patients with cirrhosis and 2594 patients with CP. The adjusted hazard ratio (HR) for any fracture was 2.4 in patients with cirrhosis (95% confidence interval [CI], 2.2-2.5) and 1.7 in patients with CP (95% CI, 1.6-1.8). The relative risk of low-trauma fractures was highest among individuals younger than 50 years old. Alcohol as an etiology was associated with an increased risk of fracture compared with patients with nonalcoholic cirrhosis (HR, 2.4 vs 1.5; P < .0001) and CP (HR, 2.0 vs 1.5; P < .0001). Patients with CP receiving PES for fat malabsorption had a lower risk of fractures than other CP patients (HR, 0.8; 95% CI, 0.7-0.9). However, increasing the duration of treatment with PES was associated with an increased risk of fracture. Conclusions: Patients, especially younger patients, with cirrhosis or CP have an increased risk of fractures of all types.

KW - Adult

KW - Age Factors

KW - Alcohol Drinking

KW - Comorbidity

KW - Dietary Fats

KW - Female

KW - Femoral Fractures

KW - Forearm Injuries

KW - Fractures, Bone

KW - Humans

KW - Leg Injuries

KW - Liver Cirrhosis

KW - Malabsorption Syndromes

KW - Male

KW - Middle Aged

KW - Pancreatitis, Chronic

KW - Retrospective Studies

KW - Risk Assessment

U2 - 10.1016/j.cgh.2013.04.031

DO - 10.1016/j.cgh.2013.04.031

M3 - Journal article

C2 - 23644391

SN - 1542-3565

VL - 12

SP - 320

EP - 326

JO - Clinical Gastroenterology and Hepatology

JF - Clinical Gastroenterology and Hepatology

IS - 2

ER -

The Risk of Fractures Among Patients With Cirrhosis or Chronic Pancreatitis

Abstract

Keywords

UN SDGs

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