Risk of fractures and postfracture mortality in 3980 people with primary biliary cholangitis: A population‐based cohort study

Abstract

Background Morbidity in primary biliary cholangitis (PBC) is multifactorial. Osteoporosis related to cholestasis is an extrahepatic complication of PBC. It is not fully established to what extent people with PBC have an increased risk for fractures, and if mortality after a fracture is increased, compared to the general population. Methods All Swedish people with PBC diagnosed between 2001 and 2016 were identified from the National Swedish Patient Register using ICD‐10 codes. Incident fractures were ascertained in the same register and compared to matched controls from the Swedish general population (1:10 for age, sex, and municipality). Cox regression was used to investigate the rates of fractures and postfracture mortality. The cumulative incidence of fractures was calculated while accounting for competing risks (death or liver transplantation). Results People with PBC (n = 3980) showed a higher risk of fractures at all‐time points during follow‐up compared to matched controls (n = 37,196), which was seen both in men and women. At 5 years of follow‐up, the cumulative incidence of any fracture in people with PBC was 16.8% (95% confidence interval [CI] = 15.6–18.1), compared to 11.6% (95%CI = 11.3–12.0) in controls. The rate of osteoporotic fractures was particularly high (adjusted Hazard ratio [aHR] = 1.9; 95% = CI 1.7–2.0). The 30‐day as well as the 1‐year mortality after a fracture was significantly higher in people with PBC compared to controls that also experienced a fracture (aHR = 2.2; 95%CI = 1.5–3.2; aHR = 2.0; 95%CI 1.7–2.4). Conclusion People with PBC have a significantly higher risk of fractures and postfracture mortality compared to matched controls from the general population.

Low screening rates and high prevalence of osteoporosis in cirrhosis: A real‐world retrospective analysis

“…12 In patients with cirrhosis, alcohol consumption, tobacco use, and sedentary lifestyle are additional risk factors for the development of osteoporosis. 12 Patients with cirrhosis are at a higher risk for osteoporosisrelated fracture compared to the general population, which can dramatically impact quality of life and mortality [13][14][15][16][17][18][19][20] (Table 2). In addition, patients with cirrhosis are more likely to develop an infection, acute kidney injury, surgical complications and have a higher mortality after a fracture compared to patients without liver disease [16][17][18][19] (Table 2).…”

Primary biliary cirrhosis and osteoporosis: a bidirectional two-sample Mendelian randomization study

“…A review study reported that the prevalence of osteoporosis in PBC ranged from 20% to 44%, with an increase in prevalence correlating to disease progression and a high incidence of fractures (10-20%) (6). A comprehensive analysis of 3,980 PBC patients revealed a significantly higher fracture risk and post-fracture mortality in these patients compared to matched controls from the general population (7). However, the relationship between PBC and osteoporosis is subject to debate.…”

Regarding: Risk of fractures and postfracture mortality in 3980 people with primary biliary cholangitis

“…Regarding: Risk of fractures and postfracture mortality in 3980 people with primary biliary cholangitis Dear Editor, We read with great interest the research conducted by Schönau et al, published in this issue of the Journal of Internal Medicine. The authors utilized a Swedish nationwide database and conducted a retrospective cohort study to evaluate the risk of fracture and related mortality events in patients with primary biliary cholangitis (PBC) [1]. Through providing large-scale real-world evaluation, results provided in the current study could be clinically important because proper evidence was lacking in previous studies.…”