Division of Epidemiology and Public Health, University of Nottingham, City Hospital Campus, Nottingham NG5 1PB, United Kingdom; School of Pharmacy, University of Nottingham, Nottingham NG7 2RD, United Kingdom; School of Medicine, University of Central Lancashire, Harrington building 242, Preston PR1 2HE, United Kingdom.
Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark; Department of Gastroenterology and Hepatology, Aalborg University Hospital, Aalborg Denmark.
J Hepatol. 2018 Sep;69(3):697-704. doi: 10.1016/j.jhep.2018.04.002. Epub 2018 Apr 17.
BACKGROUND & AIMS: Cirrhosis, the prevalence of which is increasing, is a risk factor for osteoporosis and fractures. However, little is known of the actual risk of hip fractures in patients with alcoholic cirrhosis. Using linked primary and secondary care data from the English and Danish nationwide registries, we quantified the hip fracture risk in two national cohorts of patients with alcoholic cirrhosis.
We followed 3,706 English and 17,779 Danish patients with a diagnosis of alcoholic cirrhosis, and we identified matched controls from the general populations. We estimated hazard ratios (HR) of hip fracture for patients vs. controls, adjusted for age, sex and comorbidity.
The five-year hip fracture risk was raised both in England (2.9% vs. 0.8% for controls) and Denmark (4.6% vs. 0.9% for controls). With confounder adjustment, patients with cirrhosis had fivefold (adjusted HR 5.5; 95% CI 4.3-6.9), and 8.5-fold (adjusted HR 8.5; 95% CI 7.8-9.3) increased rates of hip fracture, in England and Denmark, respectively. This association between alcoholic cirrhosis and risk of hip fracture showed significant interaction with age (p <0.001), being stronger in younger age groups (under 45 years, HR 17.9 and 16.6 for English and Danish patients, respectively) than in patients over 75 years (HR 2.1 and 2.9, respectively). In patients with alcoholic cirrhosis, 30-day mortality following a hip fracture was 11.1% in England and 10.0% in Denmark, giving age-adjusted post-fracture mortality rate ratios of 2.8(95% CI 1.9-3.9) and 2.0(95% CI 1.5-2.7), respectively.
Patients with alcoholic cirrhosis have a markedly increased risk of hip fracture and post-hip fracture mortality compared with the general population. These findings support the need for more effort towards fracture prevention in this population, to benefit individuals and reduce the societal burden.
Alcoholic cirrhosis creates a large public health burden and is a risk factor for bone fractures. Based on data from England and Denmark, we found that hip fractures occur more than five times more frequently in people with alcoholic cirrhosis than in people without the disease. Additionally, the aftermath of the hip fracture is severe, such that up to 11% of patients with alcoholic cirrhosis die within 30 days after their hip fracture. These results suggest that efforts directed towards fracture prevention in people with alcoholic cirrhosis could be beneficial.
肝硬化的发病率不断上升，是骨质疏松症和骨折的危险因素。然而，目前对于酒精性肝硬化患者髋部骨折的实际风险知之甚少。本研究利用来自英国和丹麦全国性注册中心的一级和二级医疗数据，对两个国家队列中患有酒精性肝硬化的患者的髋部骨折风险进行量化。
我们对 3706 名英国和 17779 名丹麦患有酒精性肝硬化的患者进行了随访，并从普通人群中确定了匹配的对照组。我们通过调整年龄、性别和合并症来估计患者与对照组相比髋部骨折的风险比（HR）。
在英国（2.9% vs. 0.8%）和丹麦（4.6% vs. 0.9%），五年髋部骨折风险均升高。在混杂因素调整后，肝硬化患者的髋部骨折风险增加了五倍（调整后的 HR 5.5；95%CI 4.3-6.9）和八倍（调整后的 HR 8.5；95%CI 7.8-9.3），分别在英国和丹麦。酒精性肝硬化与髋部骨折风险之间的这种关联具有显著的年龄交互作用（p <0.001），在年龄较小的年龄组（<45 岁，英国和丹麦患者的 HR 分别为 17.9 和 16.6）比年龄较大的患者（>75 岁，HR 分别为 2.1 和 2.9）更强。在患有酒精性肝硬化的患者中，英国和丹麦患者髋部骨折后的 30 天死亡率分别为 11.1%和 10.0%，年龄调整后的骨折后死亡率比值分别为 2.8（95%CI 1.9-3.9）和 2.0（95%CI 1.5-2.7）。
与普通人群相比，患有酒精性肝硬化的患者髋部骨折和髋部骨折后死亡率的风险显著增加。这些发现支持在该人群中加强骨折预防的必要性，以造福个人并减轻社会负担。
酒精性肝硬化给公共卫生带来了巨大负担，也是骨折的危险因素。基于来自英国和丹麦的数据，我们发现患有酒精性肝硬化的人发生髋部骨折的频率比没有该病的人高五倍以上。此外，髋部骨折的后果非常严重，高达 11%的患有酒精性肝硬化的患者在髋部骨折后 30 天内死亡。这些结果表明，针对患有酒精性肝硬化的人进行骨折预防的努力可能是有益的。
