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Alcoholic cirrhosis increases risk for hip fracture

Patients with alcoholic cirrhosis had a significantly higher risk for hip fracture and post-hip fracture mortality compared with the general population, according to recently published data.

“Using data from two national cohorts, we have shown an increased rate of hip fracture for people with alcoholic cirrhosis of between 5-fold to nearly 10-fold compared with the general population,” Harmony Otete, PhD, from the University of Nottingham, United Kingdom, and colleagues wrote. “Our study therefore indicates that interventions to prevent hip fracture in this population could have a significant benefit.”

Otete and colleagues obtained information on patients with alcoholic cirrhosis and matched healthy controls from an English database and from a Danish database to compare the rate of hip fracture development.

The researchers found evidence of osteoporosis in 6.3% of the English patients. Over follow-up of 177,717 person-years, the absolute hip fracture rate for patients with cirrhosis was 11.4 per 1,000 person-years (95% CI, 9.4-13.8) compared with 2.2 per 1,000 person-years (95% CI, 2-2.5) among controls.

In the Danish cohort, 3.1% of the patient population had evidence of osteoporosis. The absolute hip-fracture rate over follow-up of 753,797 person-years for patients with cirrhosis was 16 per 1,000 person-years (95% CI, 15-17) compared with 2.2 per 1,000 person-years (95% CI, 2.1-2.3) among the controls.

The cumulative hip fracture risk for English patients with cirrhosis was 1% (95% CI, 0.7-1.4) compared with 0.2% (95% CI, 0.1-0.3) in controls at 1-year follow-up, and 2.9% (95% CI, 2.3-3.6) among patients with cirrhosis compared with 0.8% (95% CI, 0.7-0.9) in controls at 5 years. Similarly, Danish patients with cirrhosis had a rate of 1.4% (95% CI, 1.2-1.6) at 1 year compared with 0.2% (95% CI, 0.1-0.2) in controls, and a rate of 4.6% (95% CI, 4.3-5) at 5 years compared with 0.9% (95% CI, 0.8-0.9) in controls.

Compared with controls, the rate of mortality at 30 days post-hip fracture was higher among English patients with cirrhosis (11% vs. 5%) and Danish patients with cirrhosis (10% vs. 6.6%). The adjusted mortality risk ratio comparing deaths in cirrhosis patients to controls was 2.8 (95% CI, 1.9-3.9) in English patients and 2 (95% CI, 1.5-2.7) in Danish patients.

In both cohorts, the researchers found that younger patients had the largest risk difference between patients with cirrhosis and controls due to the combination of a very low risk for hip fractures among young control patients and the contrasting high risk in young patients with alcoholic cirrhosis.

“Prophylaxis to reduce hip fracture occurrence in people with alcoholic cirrhosis, may have greater potential for benefit than does the currently common practice of surveillance for HCC, and certainly warrants consideration alongside it,” the researchers concluded. – by Talitha Bennett

Disclosure: The authors report no relevant financial disclosures.