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Published on: September 22, 2019
Risk Factors for the Occurrence of Femoral Fractures in Inflammatory Bowel Disease Patients: A Nationwide
Seok-Hyung Won1, Se-Heon Lee1, Sung Hoon Jung2
1Department of Orthopedic Surgery, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 03312, Republic of Korea.
Abstract:
Background/Objectives: Patients with inflammatory bowel disease (IBD) have an increased fracture risk, but whether femur fracture risk differs from that of the general population remains unclear. We compared the risks of overall femur fractures and femur fractures requiring surgery in patients with IBD versus matched controls, and evaluated the association between corticosteroid exposure and femur fracture risk in IBD. Methods: Using the Korean National Health Insurance Service database, we identified patients newly diagnosed with Crohn's disease (CD) or ulcerative colitis (UC) between 2008 and 2018. After 1:3 matching by age and sex, 33,778 patients with IBD (24,370 UC and 9408 CD) and 101,265 non-IBD controls were included. Incidence of femur fractures (overall and requiring surgery) was compared between groups. Multivariable analyses were performed to assess risk factors, including age, sex, disease subtype, comorbidity burden, and corticosteroid use duration. Results: Compared with controls, CD was associated with a higher incidence of femur fracture (HR, 2.10; 95% CI, 1.61-2.74; p < 0.001), whereas UC showed no clear association (HR, 1.15; 95% CI, 0.96-1.38; p = 0.120). In multivariable analysis, CD remained independently associated with femur fracture (HR, 1.74; 95% CI, 1.33-2.29; p < 0.001), while UC did not (HR, 0.99; 95% CI, 0.82-1.19; p = 0.890). Femur fractures requiring surgery were more frequent in both UC (HR, 1.35; 95% CI, 1.09-1.69; p = 0.028) and CD (HR, 1.67; 95% CI, 1.20-2.33; p = 0.003). Older age, female sex, higher comorbidity index, and longer corticosteroid exposure were associated with femur fracture in IBD. Conclusions: Only CD was associated with increased overall femur fracture risk; however, both CD and UC were associated with a higher risk of surgically treated femur fractures. Strategies to optimize bone health and minimize corticosteroid exposure may reduce femoral fracture risk in IBD.
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