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Incidence of orthopedic fracture greater among patients with cirrhosis

Orthopedic fractures occurred more frequently in cirrhotic patients with or without hepatic encephalopathy than among noncirrhotic controls in a recent study.

Researchers evaluated 3,764 cirrhotic patients (median age, 53 years; 65.7% men) with hepatic encephalopathy (HE) collected from the Taiwan National Health Insurance (NHI) database between 2000 and 2009. The incidence rate of orthopedic fractures for an 18-month follow-up period was determined within the cohort and compared against that of 3,764 matched cirrhotic patients without HE, as well as matched controls without HE or cirrhosis.

Fracture occurred in 4% of all patients, with incidence rates of 34.4 per 1,000 person-years for those with HE, 43.8 per 1,000 person-years for those without HE and 29.6 per 1,000 person-years among controls. Investigators determined incidence rate ratios (IRR) of 1.32 (95% CI, 1.02-1.72) for patients with HE and 1.63 (95% CI, 1.69-2.05) for those without HE compared with controls.

Cirrhotic patients had significantly higher cumulative estimated fracture rates than controls through follow-up: 4.05% for controls compared with 7.72% for patients without HE (P<.001) and 7.09% for patients with HE (P=.001).

Patients with HE had more incidence of skull fractures than controls (IRR=4.01, 1.24-12.96), while patients without HE had more spine and trunk (IRR=1.61, 1.06-2.43) and upper limb fractures (IRR=1.83, 1.24-2.69). Researchers also found that skull fractures were more common among those with HE (IRR=2.61, 1.04-6.57) compared with those without HE, while upper limb fractures were less frequent among patients without HE (IRR=0.45, 0.29-0.70).

According to multivariate analysis, factors independently associated with elevated fracture risk among patients with HE included alcoholism (HR=2.33, 1.62-3.35), cerebrovascular disease (HR=1.99, 1.32-3.01) and heart failure (HR=2.71, 1.68-4.38) (95% CI for all).

“Cirrhotic patients with or without HE are associated with an increased incidence of orthopedic fracture, though with different fracture site patterns,” the researchers wrote. “Comorbidities … are independent risk factors of fractures in HE patients. Preventive programs may be warranted to reduce the fracture risk in HE patients.”