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Fracture Risk in Patients With Inflammatory Bowel Disease: A Nationwide Population-Based Cohort Study From 1964 to 2014
Karolinska Inst, Dept Med Epidemiol & Biostat, Stockholm, Sweden;Orebro Univ Hosp, Dept Paediat, Orebro, Sweden;Univ Nottingham, Sch Med, Div Epidemiol & Publ Hlth, Nottingham, England;Columbia Univ, New York, NY 10027 USA.
Karolinska Univ Hosp, Inflammat & Infect Theme, Patient Area Gastroenterol Dermatovenerol & Rheum, Stockholm, Sweden;Karolinska Inst, Inst Med Solna, Unit Internal Med, Stockholm, Sweden.
Karolinska Inst, Inst Environm Med, Unit Biostat, Stockholm, Sweden.
Karolinska Univ Hosp, Inflammat & Infect Theme, Patient Area Gastroenterol Dermatovenerol & Rheum, Stockholm, Sweden;Karolinska Inst, Inst Med Solna, Unit Internal Med, Stockholm, Sweden.
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2019 (English)In: American Journal of Gastroenterology, ISSN 0002-9270, E-ISSN 1572-0241, Vol. 114, no 2, p. 291-304Article in journal (Refereed) Published
Abstract [en]

INTRODUCTION:Most studies on fractures in inflammatory bowel disease (IBD) are based on patients from tertiary centers or patients followed up before the introduction of immunomodulators or biologics. In addition, the role of corticosteroids in fracture risk has rarely been examined.METHODS:We conducted a nationwide population-based cohort study of 83,435 patients with incident IBD (ulcerative colitis [UC]: n = 50,162, Crohn's disease [CD]: n = 26,763, and IBD unclassified: 6,510) and 825,817 reference individuals from 1964 to 2014. Using multivariable Cox regression, we estimated hazard ratios (HRs) for hip fracture and any fracture and the association with cumulative corticosteroid exposure.RESULTS:During 1,225,415 person-years of follow-up in patients with IBD, there were 2,491 first-time hip fractures (203/100,000 person-years) compared with 20,583 hip fractures during 12,405,642 person-years in reference individuals (159/100,000 person-years). This corresponded to an HR of 1.42 (95% confidence interval [CI] = 1.36-1.48). The risk for hip fracture was higher in CD compared with UC (P < 0.001). Inflammatory bowel disease was also associated with any fracture (IBD: HR = 1.18; 95% CI = 1.15-1.20). Hazard ratios for hip fracture had not changed since the introduction of immunomodulators or biologics. Increasing exposure to corticosteroids was associated with hip fracture in both IBD and non-IBD individuals (P < 0.001), but only in elderly (>60 years) patients with IBD. The association between IBD and hip fracture was nonsignificant among individuals without corticosteroids (HR = 1.11; 95% CI = 0.86-1.44).CONCLUSIONS:Inflammatory bowel disease (CD and UC) is associated with an increased risk of hip fracture and any fracture, but not in individuals without a history of corticosteroid treatment. The association between corticosteroids and hip fracture was restricted to elderly patients with IBD.

Place, publisher, year, edition, pages
Lippincott Williams & Wilkins, 2019. Vol. 114, no 2, p. 291-304
National Category
Gastroenterology and Hepatology
Identifiers
URN: urn:nbn:se:uu:diva-382476DOI: 10.14309/ajg.0000000000000062ISI: 000463158000020PubMedID: 30730858OAI: oai:DiVA.org:uu-382476DiVA, id: diva2:1308147
Funder
Swedish Foundation for Strategic Research Swedish Cancer SocietySwedish Society of MedicineStockholm County CouncilThe Karolinska Institutet's Research FoundationAvailable from: 2019-04-30 Created: 2019-04-30 Last updated: 2019-04-30Bibliographically approved

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