Fracture risk in people with primary biliary cirrhosis: a population-based cohort study.
OBJECTIVE
Controversy exists as to whether people with primary biliary cirrhosis (PBC) have an increased risk of developing osteoporosis and the extent to which this may translate into an increased risk of fracture. We have performed a cohort study using the General Practice Research Database to quantify the excess fracture risk in people with PBC.


METHODS
We identified 930 people with PBC and 9202 age- and sex-matched control subjects. We used Cox regression to estimate the hazard ratios for any fracture, hip fracture, and ulna/radius fracture in the PBC cohort compared with the general population.


RESULTS
There were approximately 2-fold relative increases in the risk of any fracture, hip fracture, and ulna/radius fracture for the PBC cohort compared with the general population (hazard ratio [HR], 2.03; 95% confidence interval [CI]: 1.70-2.44; HR 2.14 (95% CI: 1.40-3.28), and HR, 1.96; 95% CI: 1.42-2.71, respectively). The absolute excess in fracture rates were for any fracture, 12.5 per 1000 person-years (95% CI: 8.1-16.9); for hip fracture, 1.9 per 1000 person-years (95% CI: 0.3-3.5); and for ulna/radius fracture, 3.4 per 1000 person-years (95% CI: 1.2-5.7). In those people with more severe disease, the relative risks of fracture were similar (any fracture HR, 2.24; hip fracture HR, 1.25; ulna/radius fracture HR, 1.28).


CONCLUSIONS
There are modest increases in both the absolute and relative fracture risks in people with PBC compared with the general population, with the excess risks similar in those with more severe disease.
Solaymani-Dodaran
Masoud
M
Division of Epidemiology and Public Health, University of Nottingham, Nottingham, UK.
Card
Tim R
TR
Aithal
Guruprasad P
GP
West
Joe
J
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002118:Calcium / Q000627:therapeutic use; D015331:Cohort Studies; D005260:Female; D050723:Fractures, Bone / Q000209:etiology / Q000517:prevention & control; D006620:Hip Fractures / Q000209:etiology* / Q000517:prevention & control; D006801:Humans; D008105:Liver Cirrhosis, Biliary / Q000150:complications*; D008297:Male; D008875:Middle Aged; D010024:Osteoporosis / Q000150:complications / Q000209:etiology* / Q000517:prevention & control; D016016:Proportional Hazards Models; D011885:Radius Fractures / Q000209:etiology* / Q000517:prevention & control; D012307:Risk Factors; D014807:Vitamin D / Q000627:therapeutic use
D014807:Vitamin D; D002118:Calcium