Hepatic Encephalopathy Increases the Risk of Hip Fracture: a Nationwide Cohort Study

Abstract

BackgroundOsteoporotic hip fractures debilitate the patients and largely decrease their life quality. Early prevention of the fracture is essential in the recent decades by finding out the related risk factors as reference of further intervention. Hepatic encephalopathy, a major complication of liver cirrhosis, may increase the rate of falling down and weaken the bone quality. Few papers emphasized the association between hepatic encephalopathy and osteoporotic hip fracture.MethodsThis retrospective cohort study used data from Taiwan’s National Health Insurance Research Database between 2000 and 2012. Patients with and without hepatic encephalopathy were matched at a ratio of 1:4 for age, sex, and index year. The incidence and hazard ratios of comorbidities related to aging and poor lifestyle were calculated using Cox proportional hazard regression models.ResultsIn total, 2496 patients with hepatic encephalopathy and 9984 patients without hepatic encephalopathy were enrolled. The average age of the patients was approximately 66.5 years. The incidence of comorbidities did not significantly differ between patients with and without hepatic encephalopathy. Patients with hepatic encephalopathy were 2.15-times more likely to develop osteoporotic hip fractures than patients without hepatic encephalopathy in the whole group and the risk ratio was significantly higher in female patients. Those who were aged 50–64 and 65–79 years were respectively 3.57- and 2.51-times more likely to develop osteoporotic hip fracture compared to their non-HE counterparts. The results were also similar in the comorbidity subgroups of hypertension, diabetes mellitus, hyperlipidemia, senile cataract, gastric ulcer and depression. The cumulative incidence of the fractures significantly differed between patients with and without hepatic encephalopathy.ConclusionsHepatic encephalopathy is significantly associated with an increased risk of osteoporotic hip fractures and the significance was not affected by the comorbidities. The risk cumulated steadily through time goes by.