Is Liver Cirrhosis a Risk Factor for Osteonecrosis of the Femoral Head in Adults? A Population-Based 3-Year Follow-Up Study

Hung, Tsung–Hsing; Hsieh, Yu–Hsi; Tsai, Chen-Chi; Tseng, Chih‐Wei; Tseng, Kuo‐Chih; Tsai, Chen–Chi

doi:10.2169/internalmedicine.50.5952

Cited by 9 publications

(11 citation statements)

References 36 publications

(30 reference statements)

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“…Hung et al. ( 2011 ) found an HR for AVN of 2.5 in a cohort of patients with cirrhosis (primarily due to viral hepatitis) relative to an age-matched cohort of hospitalized patients without cirrhosis. These hospitalized patients without cirrhosis had a high prevalence of conditions that predispose to AVN, but the reported associations were only adjusted for conditions recorded at the index hospitalization.…”

Section: Discussionmentioning

confidence: 99%

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Cirrhosis is a risk factor for total hip arthroplasty for avascular necrosis

et al. 2016

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Background and purposeThere are limited data on risk factors for avascular necrosis of the hip, but cirrhosis has been proposed as a risk factor. We examined the association between cirrhosis and incidence of total hip arthroplasty for avascular necrosis.MethodsWe used nationwide healthcare data to identify all Danish residents diagnosed with cirrhosis in 1994–2011, and matched them 1:5 by age and sex to non-cirrhotic reference individuals from the general population. We excluded people with a previous total hip arthroplasty, a previous hip fracture, or a previous diagnosis of avascular necrosis. We used stratified Cox regression to estimate the hazard ratio (HR) for cirrhosis patients relative to reference individuals, adjusting for potential confounders. We used the cumulative incidence function to compute 5-year risks.ResultsWe included 25,421 cirrhosis patients and 114,052 reference individuals. Their median age was 57 years, and 65% were men. 45 cirrhosis patients and 44 reference individuals underwent total hip arthroplasty for avascular necrosis. Cirrhosis patients’ HR for a total hip arthroplasty for avascular necrosis was 10 (95% CI: 6–17), yet their 5-year risk of avascular necrosis was only 0.2%. For the reference individuals, the 5-year risk was 0.02%.InterpretationCirrhosis is a strong risk factor for avascular necrosis of the hip, but it is rare even in cirrhosis patients.

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Section: Discussionmentioning

confidence: 99%

“…Hung et al. ( 2011 ) reported that cirrhosis may also be a risk factor. Their study compared the risk of AVN in cirrhosis patients and that in an age-matched cohort of hospitalized patients with a high prevalence of conditions that predispose to AVN.…”

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confidence: 99%

Cirrhosis is a risk factor for total hip arthroplasty for avascular necrosis

et al. 2016

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“…[38][39][40][41] Nevertheless, recent studies have shown liver cirrhosis, irrespective of underlying aetiology, to be an independent risk factor for the development of non-traumatic osteonecrosis regardless of oral corticosteroid use, alcohol consumption and smoking. [39][40][41] Hung et al 40 evaluated the nationwide population-based database to examine the occurrence of OFH in patients with cirrhosis and in those without cirrhosis during a 3-year follow-up. Their study cohort comprised 40,769 adult patients with liver cirrhosis compared with a comparison cohort of 40,769 randomly selected age-and sex-matched healthy subjects.…”

Section: Avascular Necrosismentioning

confidence: 99%

“…As in the general population, prior joint trauma, male gender, younger age and gouty arthritis were found to have increased risk of developing OFH. 40 MRI is certainly the imaging modality of choice, offering the highest sensitivity and specificity both for early diagnosis and in looking for complications ( Figure 12). …”

Section: Avascular Necrosismentioning

confidence: 99%

Cirrhosis-related musculoskeletal disease: radiological review

Arora¹,

Rajesh²,

Bansal³

et al. 2016

BJR

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Musculoskeletal problems in patients with liver disease are common; however, they are not so well described in the literature. Therefore, there is a need to collate information on these disorders, as their incidence is on a constant rise and some of these pathologies can severely debilitate the patient's quality of life. These disorders are parietal wall varices with or without bleeding, spontaneous intramuscular haematoma (e.g. rectus sheath), abdominal wall hernia, anasarca, hepatic osteodystrophy, septic arthritis, osteomyelitis, necrotizing fasciitis, osseous metastases from hepatocellular carcinoma etc. While portal hypertension plays a key role in disorders, in others, dysregulation of the coagulation system or a compromised immune system are responsible. Imaging plays an essential role in the assessment of these complications and awareness of these musculoskeletal manifestations is vital for establishing a timely diagnosis and planning of appropriate therapy, as these disorders can significantly impact the morbidity and mortality and also influence candidacy for liver transplantation. We herein comprehensively appraise various musculoskeletal complications associated with chronic liver disease/liver cirrhosis especially from an imaging perspective which, to the best of our knowledge, have not been collectively described in English literature.

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“…This is attributed to intestinal bacterial overgrowth and translocation, impaired phagocytosis, poor opsonisation capacity, porto-systemic shunting, and low complement levels in cirrhotic patients [ 14 – 16 ]. In addition, cirrhotic patients are prone to have osteoporosis and osteonecrosis due to poor cholecalciferol absorption through the intestine, poor activation of vitamin D, chronic hypogonadism, and overexpression of interleukin-6 [ 17 – 19 ]. However, there has been no study to confirm that liver cirrhosis is a significant risk factor for NSA due to low incidence of NSA in the general population.…”

Section: Introductionmentioning

confidence: 99%

Increased occurrence of native septic arthritis in adult cirrhotic patients: a population-based three-year follow-up study in Taiwan

Hung

Hsieh²,

Lay

et al. 2014

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IntroductionDue to impairment of immunity and metabolism, cirrhotic patients are prone to infection, osteoporosis, and osteonecrosis. However, it is unknown if cirrhotic patients are prone to native septic arthritis (NSA).AimTo assess the occurrence of NSA between cirrhotic and non-cirrhotic patients.Material and methodsWe used the Taiwan National Health Insurance Database to enrol 35,106 cirrhotic patients and 33,457 non-cirrhotic patients from January 1, 2004 to December 31, 2004. The medical record of each patient was individually followed for a 3-year period.ResultsThere were 341 (0.5%) patients having NSA in a follow-up period of 3 years: 214 cirrhotic and 127 non-cirrhotic patients. The incidence density of hospitalisation for NSA was 2.03 episodes/1000 person-years in cirrhotic patients, and 1.27 episodes/1000 person-years in non-cirrhotic patients. After adjustment for age, gender, and other comorbid disorders, Cox's regression analysis showed that cirrhotic patients had a higher occurrence of NSA than non-cirrhotic patients(hazard ratio (HR) = 1.51, 95% confidence interval (CI) = 1.19–1.90; p = 0.001). The patients with complicated cirrhosis were more prone to have NSA than those with non-complicated cirrhosis (HR = 1.46, 95% CI = 1.09–1.96, p = 0.011).ConclusionsThis analysis demonstrates that cirrhotic patients have a higher risk of NSA, particularly those with complicated cirrhosis.

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Is Liver Cirrhosis a Risk Factor for Osteonecrosis of the Femoral Head in Adults? A Population-Based 3-Year Follow-Up Study

Cited by 9 publications

References 36 publications

Cirrhosis is a risk factor for total hip arthroplasty for avascular necrosis

Cirrhosis is a risk factor for total hip arthroplasty for avascular necrosis

Cirrhosis-related musculoskeletal disease: radiological review

Increased occurrence of native septic arthritis in adult cirrhotic patients: a population-based three-year follow-up study in Taiwan

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