Fracture risk of women with primary biliary cirrhosis: no increase compared with general population controls

Abstract

Summary Aim : Patients with primary biliary cirrhosis may be at increased risk of osteoporosis but to what extent this is reflected in an increased fracture risk is unknown. We have enquired about the fracture experience of female primary biliary cirrhosis patients compared with sex‐ and age‐matched controls. Methods : Patients aged 30–75 with primary biliary cirrhosis and age‐matched controls were sent a postal questionnaire asking about their fracture history and details of risk factors for osteoporosis. Results : 85 eligible patients with primary biliary cirrhosis and 116 controls responded. Forty‐one per cent of patients with primary biliary cirrhosis and 30% of controls reported ever having had a fracture odds ratio 1.5 (95% confidence interval: 0.80–2.89). Twenty‐eight per cent of primary biliary cirrhosis patients and 23.3% of controls reported a fracture after the age of 30, odds ratio 1.2 (95% confidence interval: 0.57–2.56), and 14.1% of primary biliary cirrhosis patients and 12.1% of controls reported a low impact fracture of the long bones or of the vertebrae odds ratio 1.0 (95% confidence interval: 0.31–2.68). Conclusions : No overall increased fracture risk in patients with primary biliary cirrhosis was observed. As a group, unselected patients with primary biliary cirrhosis do not represent a population at particularly high risk of osteoporotic fracture and thus targeting them for osteoporosis screening and treatment is not justified. Further work investigating subgroups of patients with primary biliary cirrhosis at potentially high risk of osteoporosis, such as those with advanced disease or severe cholestasis is required.

The association between liver cirrhosis and fracture risk: A systematic review and meta‐analysis

“…Six studies estimated the association between LC and any fracture risk . As shown in Figure , the pooled OR was 1.94 (95% CI, 1.59‐2.37) with a high heterogeneity ( I 2 = 88.4%, P < .001).…”

“…Using this searching strategy, 2206 citations were retrieved, of which 32 articles were assessed in full-text format. Eventually, 8 of these were identified, 6,7,[11][12][13][14][15][16] which were composed of 5 cohort and 3 case-control studies, including 321 035 subjects and 31 272 fracture cases. The characteristics of each study are shown in Table 1.…”

“…Previous studies determined that LC was associated with an increased risk of osteoporosis; however, the association between LC and fracture risk was inconclusive . Fractures may lead to functional impairment, decreases in quality of life and death .…”

“…2 Although the epidemiology, aetiology, prevention and treatment of LC have been well studied, complications of LC are not well elucidated.Previous studies determined that LC was associated with an increased risk of osteoporosis 3-5 ; however, the association between LC and fracture risk was inconclusive. 6,7 Fractures may lead to functional impairment, decreases in quality of life and death. 8The goal of this current systematic review with meta-analysis was to explore the association between LC and fracture risk.…”

Osteoporosis in Gastrointestinal Diseases

“…A two-fold increase in risk of the overall fracture of bones and fracture of the proximal femur and the forearm was observed in a group of 930 patients with primary biliary cirrhosis, in comparison to the general population (n = 9.202) [16]. Low-energy fractures occur in 14-21% of patients with chronic hepatitis and patients with liver cirrhosis and 45% in patients with end-stage liver failure referred for liver transplant [17]. Osteoporosis occurred in 36.6% and osteopenia in 48.1% of a group of 243 patients with chronic liver disease in the preparatory period for liver transplant [18].…”