title: The risk of fractures among patients with cirrhosis or chronic pancreatitis.
abstract: OBJECTIVE
  Cirrhosis and chronic pancreatitis (CP) are accompanied by inflammation and malnutrition. Both conditions can have negative effects on bone metabolism and promote fractures. We evaluated the risk of fractures among patients with CP or cirrhosis and determined the effect of fat malabsorption on fracture risk among patients with CP.
  
  
  METHODS
  We performed a retrospective cohort study using the Danish National Patient Register to identify patients diagnosed with CP or cirrhosis. We analyzed data collected from January 1, 1995, to December 31, 2010, on 20,769 patients (35.5% women with cirrhosis and 11,972 patients (33.5% women) with CP. Each patient was compared with 10 age- and sex-matched controls. We also assessed the risk of fractures among patients with CP who received pancreatic enzyme substitution (PES) for fat malabsorption.
  
  
  RESULTS
  During the study period, bone fractures occurred in 3954 patients with cirrhosis and 2594 patients with CP. The adjusted hazard ratio (HR) for any fracture was 2.4 in patients with cirrhosis (95% confidence interval [CI], 2.2-2.5) and 1.7 in patients with CP (95% CI, 1.6-1.8). The relative risk of low-trauma fractures was highest among individuals younger than 50 years old. Alcohol as an etiology was associated with an increased risk of fracture compared with patients with nonalcoholic cirrhosis (HR, 2.4 vs 1.5; P < .0001) and CP (HR, 2.0 vs 1.5; P < .0001). Patients with CP receiving PES for fat malabsorption had a lower risk of fractures than other CP patients (HR, 0.8; 95% CI, 0.7-0.9). However, increasing the duration of treatment with PES was associated with an increased risk of fracture.
  
  
  CONCLUSIONS
  Patients, especially younger patients, with cirrhosis or CP have an increased risk of fractures of all types.
authors: Department of Endocrinology, University Hospital of Hvidovre, Hvidovre, Denmark. Electronic address: ulrichbangbang@gmail.com.
authors: Ulrich Christian
authors: UC
authors: Bang
authors: Department of Infectious Diseases, University Hospital of Hvidovre, Hvidovre, Denmark; Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
authors: Thomas
authors: T
authors: Benfield
authors: Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Department of Gastroenterology, University Hospital of Hvidovre, Hvidovre, Denmark.
authors: Flemming
authors: F
authors: Bendtsen
authors: Department of Endocrinology, University Hospital of Hvidovre, Hvidovre, Denmark; Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
authors: Lars
authors: L
authors: Hyldstrup
authors: Department of Endocrinology, University Hospital of Hvidovre, Hvidovre, Denmark; Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
authors: Jens-Erik
authors: JE
authors: Beck Jensen
mesh_terms: D000328:Adult; D000367:Age Factors; D000428:Alcohol Drinking / Q000453:epidemiology; D015897:Comorbidity; D004041:Dietary Fats / Q000378:metabolism; D005260:Female; D005264:Femoral Fractures / Q000453:epidemiology; D005543:Forearm Injuries / Q000453:epidemiology; D050723:Fractures, Bone / Q000453:epidemiology*; D006801:Humans; D007869:Leg Injuries / Q000453:epidemiology; D008103:Liver Cirrhosis / Q000453:epidemiology*; D008286:Malabsorption Syndromes / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D050500:Pancreatitis, Chronic / Q000453:epidemiology*; D012189:Retrospective Studies; D018570:Risk Assessment
chemical_list: D004041:Dietary Fats
keywords: BMD; CI; CP; CPD; Database Analysis; Fibrosis; HR; IR; Liver Disease; Orthopedic; PBC; PES; PY; RANK; bone mineral density; chronic pancreatitis; chronic pulmonary disease; confidence interval; hazard ratio; incidence rate; pancreatic enzymes substitution; person-years; primary biliary cirrhosis; receptor activator of nuclear factor-κB