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Increased risk of fragility fractures in patients with primary biliary cholangitis
Jihye Lim1, Ye-Jee Kim2, Sehee Kim2
1Division of Gastroenterology and Hepatology, Department of Internal Medicine, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, 07345, Republic of Korea.
Insights
Patients with primary biliary cholangitis (PBC) have a significantly higher risk of fragility fractures, particularly in the spine and hip. This study highlights the need for increased awareness and preventive strategies for bone health in PBC patients.
Area of Science:
- Hepatology
- Orthopedics
- Epidemiology
Background:
- Primary biliary cholangitis (PBC) is a chronic liver disease with limited large-scale studies on fragility fracture risk.
- Fragility fractures contribute significantly to morbidity and mortality.
Purpose of the Study:
- To investigate the association between primary biliary cholangitis and the risk of fragility fractures.
- To utilize real-world nationwide data for a population-based cohort study.
Main Methods:
- Analysis of Korean National Health Insurance Service claims data (2007-2020).
- Matched cohort study comparing 4951 PBC patients with 19,793 controls (1:4 ratio).
- Primary outcome: fragility fractures (vertebra, hip, distal radius, proximal humerus); assessed using incidence rates and hazard ratios.
Main Results:
- Patients with PBC had a 1.63-fold increased risk of fragility fractures (adjusted HR: 1.63, 95% CI: 1.20-2.22, P=.002).
- Vertebral and hip fractures were particularly common in PBC patients (adjusted HRs: 1.77 and 2.23, respectively).
- Subgroup analysis revealed higher risks in men (2.53-fold) and women (1.59-fold) with PBC.
Conclusions:
- Primary biliary cholangitis is significantly associated with an increased risk of fragility fractures.
- Patients with PBC require heightened awareness and proactive management strategies for fracture prevention.
- Further research into the mechanisms and targeted interventions for bone health in PBC is warranted.
Abstract:
Large-scale studies on the risk of fragility fractures in patients with primary biliary cholangitis (PBC) are limited due to low incidence. We aimed to investigate whether PBC is associated with fragility fractures using real-world nationwide data. The Korean National Health Insurance Service claims data from 2007 to 2020 were analyzed in this population-based cohort study. Patients with PBC (n = 4951) were matched with controls (n = 19 793) using a 1:4 ratio based on age, sex, and follow-up duration. The primary outcome was fragility fracture, which comprised fractures of the vertebra, hip, distal radius, and proximal humerus. The incidence rates (IRs) and hazard ratios (HRs) were determined to assess the impact of PBC on fragility fractures. During the median follow-up period of 5.37 years, 524 patients in the PBC group had fragility fractures (IR, 18.59/1000 person-years [PYs]). After adjusting for covariates, PBC increased the risk of fragility fractures by 1.63-fold (95% confidence interval, 1.20-2.22; P = .002). The vertebra and hip were particularly susceptible to fracture in patients with PBC, with adjusted HRs of 1.77 and 2.23, respectively. In the subgroup analysis, the risk of fragility fracture was 2.53-fold higher in men and 1.59-fold higher in women with PBC than that in the respective matched control groups. Considering the morbidity and mortality related to fragility fractures, increasing awareness of fragility fracture risk and implementing appropriate preventive measures in patients with PBC are imperative.
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