Alcohol-Related Cirrhosis Associated With Increased Fracture and Mortality Rate

alcohol liver disease
alcohol liver disease
Researchers investigated the rate and risk for fractures and postfracture mortality among patients with alcohol-related cirrhosis.

Patients with alcohol-related cirrhosis have an almost 4-fold increased fracture rate as well as an increased 30-day and 1-year postfracture mortality rate compared with the general population, according to study results published in Clinical Gastroenterology and Hepatology.

The population-based cohort study evaluated the rate and risk of any fracture and mortality after fracture in patients with alcohol-related cirrhosis compared with the general population on a national level.

Data were obtained from the Swedish National Patient Registry (NPR) for all patients with a diagnostic code for alcohol-related cirrhosis between January 1, 1969, and December 31, 2016. The patients with alcohol-related cirrhosis were matched for age, sex, and municipality with as many as 10 control individuals from the general population from the Total Population Registry. The primary outcome was the time until the first fracture.

A total of 25,090 patients with alcohol-related cirrhosis and 239,458 matched general population control individuals were included and followed for 3,468,860 person-years (94,663 in patients and 3,374,196 in control individuals). Overall, participants’ median age was 60 years, and 76% were men.

During the follow-up, 3659 (14.6%) patients and 44,976 (18.8%) control individuals had at least 1 fracture. Osteoporosis was the most common presumed mechanism in patients (n=1806; 49.4%) and control individuals (n=23,492; 52.2%).

The incidence of any fracture was increased among patients who had alcohol-related cirrhosis (38.7 per 1000 person-years) compared with the control group (13.3 per 1000 person-years). The corresponding adjusted hazard ratio (aHR) for any fracture was 3.8 (95% CI, 3.6-3.9; P <.001).

The risk for any fracture was greater among patients with alcohol-related cirrhosis compared with control individuals at 1 year (2.9%; 95% CI, 2.7-3.2 vs 0.9%; 95% CI, 0.9-1.0), 5 years (9.6%; 95% CI, 9.2-10.0 vs 4.5%; 95% CI, 4.4-4.6), and 10 years (13.5%; 95% CI, 13.0-13.9 vs 8.7%; 95% CI, 8.6-8.8), but not at the full follow-up of 48 years (17.2%; 95% CI, 16.7-17.7 vs 30.8%; 95% CI, 30.5-31.1).

The patients with alcohol-related cirrhosis had a greater risk for any fracture during the first 19 years after an initial diagnosis, and then their fracture risk was lower compared with the general population.

Patients with alcohol-related cirrhosis also had an increased mortality rate after fracture compared with control individuals at 30 days (aHR, 1.6; 95% CI, 1.4-1.8; P <.001) and 1 year (aHR, 1.8; 95% CI, 1.7-2.0; P <.001).

Study limitations include no access to possible confounders, such as corticosteroid therapy, body mass index, the extent of alcohol use, or smoking. Also, early-stage cirrhosis may have been missed, as the analysis included patients based on diagnostic coding in electronic health records. Furthermore, fractures were categorized based on their mechanisms, but the reliance on International Classification of Diseases codes can lead to misclassification.

“The increased rates of fractures and postfracture death were seen independent of presumed fracture pathophysiology, such as osteoporosis or high-energy trauma,” the researchers wrote. “Preventive interventions to reduce modifiable risk factors for fractures are needed in this population and might diminish the risk of early death in patients with alcohol-related cirrhosis.”

Reference

Wester A, Ndegwa N, Hagström H. Risk of fractures and subsequent mortality in alcohol-related cirrhosis: a nationwide population-based cohort study. Clin Gastroenterol Hepatol. Published online July 7, 2022. doi:10.1016/j.cgh.2022.05.048