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Increased Risk for Hip Fractures among Patients with Cholangitis: A Nationwide Population-Based Study
Chieh-Cheng Hsu1, Horng-Chaung Hsu2,3, Che-Chen Lin4
1Department of Orthopaedic Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan.
Insights
Cholangitis, an infection of the biliary tract, increases the risk of hip fracture. This risk is particularly elevated in younger individuals without other medical conditions.
Area of Science:
- Medical research
- Epidemiology
- Bone health
Background:
- Cholangitis is an infectious biliary tract disease that can cause systemic inflammation.
- Systemic inflammation is linked to bone loss and osteoporosis.
- Osteoporosis is a major risk factor for hip fractures.
Purpose of the Study:
- To investigate the association between cholangitis and the risk of hip fracture.
- To determine if cholangitis contributes to an increased incidence of hip fractures.
Main Methods:
- A cohort study design was employed, including patients diagnosed with cholangitis between 2001 and 2009.
- Exclusion criteria included cancer history, trauma, and prior fractures.
- Controls without cholangitis were matched by age, sex, osteoporosis, and steroid use (1:4 ratio).
Main Results:
- The cholangitis cohort (2735 subjects) had a higher hip fracture incidence density (7.58 per 1000 person-years) compared to the non-cholangitis cohort (5.86 per 1000 person-years).
- Cholangitis was associated with a 1.29-fold increased risk of hip fracture (HR=1.29, 95% CI=1.03-1.61).
- The association was stronger in subjects under 65 (HR=2.65) and those without comorbidities (HR=3.01).
Conclusions:
- Cholangitis is significantly associated with an increased risk of hip fracture.
- The risk is notably higher in younger individuals and those without pre-existing medical comorbidities.
Background:
Cholangitis is the infectious disease involving the biliary tract, which may induce systemic inflammation. Bone loss is a well-known sequelae after systemic inflammatory disease, and one grave complication after osteoporosis is hip fracture. We want to know whether cholangitis can contribute to increased risk of hip fracture.
Methods:
All the patients diagnosed with cholangitis since January 1, 2001, to December 31, 2009, were assessed. All the subjects with cancer history, traumatic accident, and previous fracture were excluded. We selected the controls without cholangitis and matched the controls to cholangitis patients by age, sex, osteoporosis, and the use of steroid for more than 30 days by approximately 1:4 ratio.
Results:
There were 2735 subjects in the cholangitis cohort and 10915 in the noncholangitis cohort. There were 101 hip fractures in the cholangitis cohort with the incidence density of 7.58 per 1000 person-years. As for the noncholangitis cohort, 366 individuals suffered from hip fracture with the incidence density of 5.86 per 1000 person-years. The risk of hip fracture was higher in the cholangitis cohort with a 1.29-fold increased risk than the noncholangitis cohort (hazard ratio = 1.29, 95% confidence interval = 1.03-1.61). The association between cholangitis and the hip fracture was more prominent among subjects less than 65 years (hazard ratio = 2.65, 95% confidence interval =1.30-5.39) and the subjects without comorbidities (hazard ratio = 3.01, 95% confidence interval = 1.42-6.41).
Conclusions:
Cholangitis is associated with higher risk for hip fracture, especially among young subjects free from medical comorbidities.
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