Division of Gastroenterology and Hepatology, Department of Internal Medicine, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
Am J Gastroenterol. 2024 Jan 1;119(1):127-137. doi: 10.14309/ajg.0000000000002354. Epub 2023 Jun 13.
INTRODUCTION: Few large-scale studies have been published regarding the association between autoimmune hepatitis (AIH) and risk of osteoporotic fracture. This study aimed to determine the risk of developing an osteoporotic fracture in patients with AIH. METHODS: We used claims data from the Korean National Health Insurance Service between 2007 and 2020. Patients with AIH (n = 7,062) were matched with controls (n = 28,122) based on age, sex, and duration of follow-up using a ratio of 1:4. Osteoporotic fractures included fractures of the vertebrae, hip, distal radius, and proximal humerus. The incidence rate (IR) and IR ratio of osteoporotic fracture were compared between the 2 groups, and their associated factors were evaluated. RESULTS: During a median follow-up period of 5.4 years, 712 osteoporotic fractures occurred in patients with AIH with an IR of 17.5 per 1,000 person-years. Patients with AIH had a significantly higher risk of osteoporotic fractures than matched controls, with an IR ratio of 1.24 (95% confidence intervals, 1.10-1.39, P < 0.01) in the multivariable analysis. Female sex, older age, history of stroke, presence of cirrhosis, and use of glucocorticoids were associated with an increased risk of osteoporotic fractures. In the 2-year landmark analysis, longer duration of glucocorticoid exposure was associated with an incremental increased risk of osteoporotic fracture. DISCUSSION: Patients with AIH had an increased risk of osteoporotic fracture compared with controls. The presence of cirrhosis and long-term use of glucocorticoids further adversely affected osteoporotic fracture in patients with AIH.
简介：鲜有大规模研究探讨自身免疫性肝炎（AIH）与骨质疏松性骨折风险之间的关联。本研究旨在确定 AIH 患者发生骨质疏松性骨折的风险。
方法：我们使用了 2007 年至 2020 年韩国国家健康保险服务的理赔数据。根据年龄、性别和随访时间，将 AIH 患者（n=7062）与对照组（n=28122）进行匹配，匹配比例为 1:4。骨质疏松性骨折包括椎体、髋部、桡骨远端和肱骨近端骨折。比较两组患者的骨质疏松性骨折发生率（IR）和 IR 比值，并评估其相关因素。
结果：在中位随访 5.4 年期间，7062 名 AIH 患者中有 712 人发生了骨质疏松性骨折，IR 为 17.5/1000 人年。多变量分析显示，AIH 患者发生骨质疏松性骨折的风险显著高于匹配对照组，IR 比值为 1.24（95%置信区间，1.10-1.39，P<0.01）。女性、年龄较大、有中风史、存在肝硬化和使用糖皮质激素与骨质疏松性骨折风险增加相关。在 2 年时间点分析中，较长时间的糖皮质激素暴露与骨质疏松性骨折风险的递增增加相关。
讨论：与对照组相比，AIH 患者发生骨质疏松性骨折的风险增加。肝硬化和长期使用糖皮质激素进一步对 AIH 患者的骨质疏松性骨折产生不利影响。
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