Hip fractures in patients with inflammatory bowel disease and their relationship to corticosteroid use: a population based cohort study
Hip fractures in patients with inflammatory bowel disease and their relationship to corticosteroid use: a population based cohort study
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DOI：
10.1136/gut.2003.026799
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发表时间：
2004-02-01
期刊：
影响因子：
24.5
通讯作者：
Logan, RFA
中科院分区：
文献类型：
--
作者：
Card, T;West, J;Logan, RFA
背景资料：炎症性肠病（IBD）已知与骨密度降低有关，但这导致骨折风险增加的程度以及皮质类固醇治疗的作用尚不清楚。我们已经进行了一个大型队列研究，以解决这些问题。方法：我们选择的主题在全科医学研究数据库（GPRD）与IBD的诊断和多达五个匹配的控制，为每个病人。我们得出了记录的髋部骨折的日期，以及吸烟、使用皮质类固醇和一些其他药物的信息。我们计算了骨折的绝对风险和相对风险作为风险比校正可用的混杂因素通过考克斯regression.Results：72髋骨折记录在16 550 IBD病例和223在82 917对照。考克斯模型得出所有IBD、溃疡性结肠炎（UC）和克罗恩病（CD）发生髋部骨折的未校正相对风险分别为1.62（95%置信区间（CI）1.24 - 2.11）、1.49（1.04-2.15）和2.08（1.36-3.18）。多变量建模表明，皮质类固醇的当前和累积使用以及阿片类镇痛药的使用都混淆了这种关系。调整混杂因素后，UC和CD的相对危险度分别为1.41（0.94-2.11）和1.68（1.01-2.78）。结论：IBD患者髋部骨折的危险性增加约60%。皮质类固醇的使用是造成这种情况的一个因素，无论是从长期来看（如之前所认识到的那样），还是以急性可逆的方式。然而，IBD患者中的大多数髋部骨折风险不能归因于类固醇的使用。
Background: Inflammatory bowel disease (IBD) is known to be associated with reduced bone density but the extent to which this results in an increased risk of fracture and the contribution of corticosteroid therapy are unclear. We have conducted a large cohort study to address these issues.Methods: We selected subjects within the General Practice Research Database (GPRD) with a diagnosis of IBD and up to five matched controls for each patient. We derived dates of recorded hip fractures and also information on smoking, use of corticosteroids, and a number of other drugs. We calculated the absolute risk of fracture and the relative risk as a hazard ratio corrected for available confounders by Cox regression.Results: Seventy two hip fractures were recorded in 16 550 IBD cases and 223 in 82 917 controls. Cox modelling gave an unadjusted relative risk of hip fracture of 1.62 (95% confidence interval (CI) 1.24-2.11) for all IBD, 1.49 (1.04-2.15) for ulcerative colitis (UC) and 2.08 (1.36-3.18) for Crohn's disease ( CD). Multivariate modelling showed that both current and cumulative use of corticosteroids and use of opioid analgesics confounded this relationship. After adjusting for confounding, the relative risk was 1.41 (0.94-2.11) for UC and 1.68 (1.01-2.78) for CD.Conclusion: The risk of hip fracture is increased approximately 60% in IBD patients. Corticosteroid use is a contributor to this, both in the long term as previously recognised and also in an acute reversible manner. The majority of hip fracture risk in IBD patients however cannot be attributed to steroid use.