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Fracture Risk in Patients With Inflammatory Bowel Disease: A Nationwide Population-Based Cohort Study From 1964 to 2014
Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Department of Paediatrics, Örebro University Hospital, Örebro, Sweden; Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, UK; Columbia University, New York, USA.ORCID iD: 0000-0003-1024-5602
Patient Area Gastroenterology, Dermatovenerology and Rheumatology, Inflammation and Infection Theme Karolinska University Hospital, Stockholm, Sweden; Unit of Internal Medicine, Institute Medicine Solna, Karolinska Institutet, Stockholm, Sweden.
Unit of Biostatistics, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
Patient Area Gastroenterology, Dermatovenerology and Rheumatology, Inflammation and Infection Theme Karolinska University Hospital, Stockholm, Sweden; Unit of Internal Medicine, Institute Medicine Solna, Karolinska Institutet, 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:oru:diva-73777DOI: 10.14309/ajg.0000000000000062ISI: 000463158000020PubMedID: 30730858Scopus ID: 2-s2.0-85061243644OAI: oai:DiVA.org:oru-73777DiVA, id: diva2:1305252
Funder
Swedish Society of MedicineThe Karolinska Institutet's Research FoundationStockholm County CouncilThe Karolinska Institutet's Research FoundationSwedish Cancer Society
Note

Funding Agencies:

Swedish Medical Society (Ihre Foundation)

Mag-tarmfonden  

Jane and Dan Olsson Foundation  

Mjölkdroppen Foundation 

Bengt Ihre Research Fellowship in gastroenterology

Available from: 2019-04-16 Created: 2019-04-16 Last updated: 2019-04-16Bibliographically approved

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Ludvigsson, Jonas F.

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