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Erschienen in: Digestive Diseases and Sciences 1/2011

01.01.2011 | Original Article

Fracture-Associated Hospitalizations in Patients with Inflammatory Bowel Disease

verfasst von: Ashwin N. Ananthakrishnan, Emily L. McGinley, David G. Binion, Kia Saeian

Erschienen in: Digestive Diseases and Sciences | Ausgabe 1/2011

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Abstract

Background

Maintenance of bone health is an important concern in patients with inflammatory bowel disease (IBD). They may frequently have impaired bone density resulting in greater incidence of fractures.

Aims

To examine fracture-associated hospitalization costs in IBD patients from a nationwide representative sample, and to compare the risk factors for such fractures in IBD and non-IBD patients.

Methods

We identified discharges with IBD and coexisting codes for hip, vertebral or wrist fractures (IBD-Fr) from the Nationwide Inpatient Sample and compared them with IBD hospitalizations without codes for these fractures. A second analysis was performed using 2008 inpatient data from the Wisconsin Hospital Association (WHA) comparing characteristics of patients with IBD-Fr and non-IBD controls hospitalized for similar fractures.

Results

There were 1,653 discharges in the IBD-Fr group accounting for 10,461 days of hospital stay and US $46 million in total hospitalization charges. On multivariate analysis, age >65 years [odds ratio (OR) 28.8, 95% confidence interval (CI) 12.3–67.6] and female sex (OR 1.3, 95%CI 1.0–1.6) were associated with higher odds of hospitalization associated with fractures. We found no differences in age, gender, or race among IBD-Fr and non-IBD fracture controls. However, IBD-fractures were twice as likely to be associated with osteoporosis as non-IBD fractures (OR 2.19, 95%CI 1.10–4.33).

Conclusions

Older age, female sex, and osteoporosis were more commonly associated with hospitalization for fractures in IBD patients. Osteoporosis appears to be more common among IBD-Fr patients than non-IBD fracture controls.
Literatur
1.
Zurück zum Zitat Moscandrew M, Mahadevan U, Kane S. General health maintenance in IBD. Inflamm Bowel Dis. 2009;15:1399–1409.CrossRefPubMed Moscandrew M, Mahadevan U, Kane S. General health maintenance in IBD. Inflamm Bowel Dis. 2009;15:1399–1409.CrossRefPubMed
2.
Zurück zum Zitat Bernstein CN. Osteoporosis and other complications of inflammatory bowel disease. Curr Opin Gastroenterol. 2002;18:428–434.CrossRefPubMed Bernstein CN. Osteoporosis and other complications of inflammatory bowel disease. Curr Opin Gastroenterol. 2002;18:428–434.CrossRefPubMed
3.
Zurück zum Zitat Bernstein CN. Osteoporosis in patients with inflammatory bowel disease. Clin Gastroenterol Hepatol. 2006;4:152–156.CrossRefPubMed Bernstein CN. Osteoporosis in patients with inflammatory bowel disease. Clin Gastroenterol Hepatol. 2006;4:152–156.CrossRefPubMed
4.
Zurück zum Zitat Bernstein CN, Leslie WD. Review article: Osteoporosis and inflammatory bowel disease. Aliment Pharmacol Ther. 2004;19:941–952.CrossRefPubMed Bernstein CN, Leslie WD. Review article: Osteoporosis and inflammatory bowel disease. Aliment Pharmacol Ther. 2004;19:941–952.CrossRefPubMed
5.
Zurück zum Zitat Bernstein CN, Leslie WD, Leboff MS. AGA technical review on osteoporosis in gastrointestinal diseases. Gastroenterology. 2003;124:795–841.CrossRefPubMed Bernstein CN, Leslie WD, Leboff MS. AGA technical review on osteoporosis in gastrointestinal diseases. Gastroenterology. 2003;124:795–841.CrossRefPubMed
6.
Zurück zum Zitat Boot AM, Bouquet J, Krenning EP, de Muinck Keizer-Schrama SM. Bone mineral density and nutritional status in children with chronic inflammatory bowel disease. Gut. 1998;42:188–194.CrossRefPubMed Boot AM, Bouquet J, Krenning EP, de Muinck Keizer-Schrama SM. Bone mineral density and nutritional status in children with chronic inflammatory bowel disease. Gut. 1998;42:188–194.CrossRefPubMed
7.
Zurück zum Zitat Robinson RJ, al-Azzawi F, Iqbal SJ, et al. Osteoporosis and determinants of bone density in patients with Crohn’s disease. Dig Dis Sci. 1998;43:2500–2506.CrossRefPubMed Robinson RJ, al-Azzawi F, Iqbal SJ, et al. Osteoporosis and determinants of bone density in patients with Crohn’s disease. Dig Dis Sci. 1998;43:2500–2506.CrossRefPubMed
8.
Zurück zum Zitat Tilg H, Moschen AR, Kaser A, Pines A, Dotan I. Gut, inflammation and osteoporosis: Basic and clinical concepts. Gut. 2008;57:684–694.CrossRefPubMed Tilg H, Moschen AR, Kaser A, Pines A, Dotan I. Gut, inflammation and osteoporosis: Basic and clinical concepts. Gut. 2008;57:684–694.CrossRefPubMed
9.
Zurück zum Zitat Leslie WD, Miller N, Rogala L, Bernstein CN. Vitamin D status and bone density in recently diagnosed inflammatory bowel disease: the Manitoba IBD Cohort Study. Am J Gastroenterol. 2008;103:1451–1459.CrossRefPubMed Leslie WD, Miller N, Rogala L, Bernstein CN. Vitamin D status and bone density in recently diagnosed inflammatory bowel disease: the Manitoba IBD Cohort Study. Am J Gastroenterol. 2008;103:1451–1459.CrossRefPubMed
10.
Zurück zum Zitat Redlich K, Hayer S, Ricci R, et al. Osteoclasts are essential for TNF-alpha-mediated joint destruction. J Clin Invest. 2002;110:1419–1427.PubMed Redlich K, Hayer S, Ricci R, et al. Osteoclasts are essential for TNF-alpha-mediated joint destruction. J Clin Invest. 2002;110:1419–1427.PubMed
11.
Zurück zum Zitat Wei S, Kitaura H, Zhou P, Ross FP, Teitelbaum SL. IL-1 mediates TNF-induced osteoclastogenesis. J Clin Invest. 2005;115:282–290.PubMed Wei S, Kitaura H, Zhou P, Ross FP, Teitelbaum SL. IL-1 mediates TNF-induced osteoclastogenesis. J Clin Invest. 2005;115:282–290.PubMed
12.
Zurück zum Zitat Bernstein CN, Blanchard JF, Leslie W, Wajda A, Yu BN. The incidence of fracture among patients with inflammatory bowel disease. A population-based cohort study. Ann Intern Med. 2000;133:795–799.PubMed Bernstein CN, Blanchard JF, Leslie W, Wajda A, Yu BN. The incidence of fracture among patients with inflammatory bowel disease. A population-based cohort study. Ann Intern Med. 2000;133:795–799.PubMed
13.
Zurück zum Zitat Card T, West J, Hubbard R, Logan RF. Hip fractures in patients with inflammatory bowel disease and their relationship to corticosteroid use: a population based cohort study. Gut. 2004;53:251–255.CrossRefPubMed Card T, West J, Hubbard R, Logan RF. Hip fractures in patients with inflammatory bowel disease and their relationship to corticosteroid use: a population based cohort study. Gut. 2004;53:251–255.CrossRefPubMed
14.
Zurück zum Zitat Loftus EV Jr, Achenbach SJ, Sandborn WJ, Tremaine WJ, Oberg AL, Melton LJ 3rd. Risk of fracture in ulcerative colitis: a population-based study from Olmsted County, Minnesota. Clin Gastroenterol Hepatol. 2003;1:465–473.CrossRefPubMed Loftus EV Jr, Achenbach SJ, Sandborn WJ, Tremaine WJ, Oberg AL, Melton LJ 3rd. Risk of fracture in ulcerative colitis: a population-based study from Olmsted County, Minnesota. Clin Gastroenterol Hepatol. 2003;1:465–473.CrossRefPubMed
15.
Zurück zum Zitat Loftus EV Jr, Crowson CS, Sandborn WJ, Tremaine WJ, O’Fallon WM, Melton LJ 3rd. Long-term fracture risk in patients with Crohn’s disease: a population-based study in Olmsted County, Minnesota. Gastroenterology. 2002;123:468–475.CrossRefPubMed Loftus EV Jr, Crowson CS, Sandborn WJ, Tremaine WJ, O’Fallon WM, Melton LJ 3rd. Long-term fracture risk in patients with Crohn’s disease: a population-based study in Olmsted County, Minnesota. Gastroenterology. 2002;123:468–475.CrossRefPubMed
16.
Zurück zum Zitat Persad R, Jaffer I, Issenman RM. The prevalence of long bone fractures in pediatric inflammatory bowel disease. J Pediatr Gastroenterol Nutr. 2006;43:597–602.CrossRefPubMed Persad R, Jaffer I, Issenman RM. The prevalence of long bone fractures in pediatric inflammatory bowel disease. J Pediatr Gastroenterol Nutr. 2006;43:597–602.CrossRefPubMed
17.
Zurück zum Zitat van Staa TP, Cooper C, Brusse LS, Leufkens H, Javaid MK, Arden NK. Inflammatory bowel disease and the risk of fracture. Gastroenterology. 2003;125:1591–1597.CrossRefPubMed van Staa TP, Cooper C, Brusse LS, Leufkens H, Javaid MK, Arden NK. Inflammatory bowel disease and the risk of fracture. Gastroenterology. 2003;125:1591–1597.CrossRefPubMed
18.
Zurück zum Zitat Andreassen H, Hylander E, Rix M. Gender, age, and body weight are the major predictive factors for bone mineral density in Crohn’s disease: A case-control cross-sectional study of 113 patients. Am J Gastroenterol. 1999;94:824–828.CrossRefPubMed Andreassen H, Hylander E, Rix M. Gender, age, and body weight are the major predictive factors for bone mineral density in Crohn’s disease: A case-control cross-sectional study of 113 patients. Am J Gastroenterol. 1999;94:824–828.CrossRefPubMed
19.
Zurück zum Zitat Leslie WD, Miller N, Rogala L, Bernstein CN. Body mass and composition affect bone density in recently diagnosed inflammatory bowel disease: the Manitoba IBD Cohort Study. Inflamm Bowel Dis. 2009;15:39–46.CrossRefPubMed Leslie WD, Miller N, Rogala L, Bernstein CN. Body mass and composition affect bone density in recently diagnosed inflammatory bowel disease: the Manitoba IBD Cohort Study. Inflamm Bowel Dis. 2009;15:39–46.CrossRefPubMed
22.
Zurück zum Zitat Gage BF, Birman-Deych E, Radford MJ, Nilasena DS, Binder EF. Risk of osteoporotic fracture in elderly patients taking warfarin: Results from the National Registry of Atrial Fibrillation 2. Arch Intern Med. 2006;166:241–246.CrossRefPubMed Gage BF, Birman-Deych E, Radford MJ, Nilasena DS, Binder EF. Risk of osteoporotic fracture in elderly patients taking warfarin: Results from the National Registry of Atrial Fibrillation 2. Arch Intern Med. 2006;166:241–246.CrossRefPubMed
23.
Zurück zum Zitat Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: Development and validation. J Chronic Dis. 1987;40:373–383.CrossRefPubMed Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: Development and validation. J Chronic Dis. 1987;40:373–383.CrossRefPubMed
24.
Zurück zum Zitat Deyo RA, Cherkin DC, Ciol MA. Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases. J Clin Epidemiol. 1992;45:613–619.CrossRefPubMed Deyo RA, Cherkin DC, Ciol MA. Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases. J Clin Epidemiol. 1992;45:613–619.CrossRefPubMed
25.
Zurück zum Zitat Curtis JR, Taylor AJ, Matthews RS, et al. “Pathologic” fractures: should these be included in epidemiologic studies of osteoporotic fractures? Osteoporos Int. 2009;20:1969–1972.CrossRefPubMed Curtis JR, Taylor AJ, Matthews RS, et al. “Pathologic” fractures: should these be included in epidemiologic studies of osteoporotic fractures? Osteoporos Int. 2009;20:1969–1972.CrossRefPubMed
26.
Zurück zum Zitat Stockbrugger RW, Schoon EJ, Bollani S, et al. Discordance between the degree of osteopenia and the prevalence of spontaneous vertebral fractures in Crohn’s disease. Aliment Pharmacol Ther. 2002;16:1519–1527.CrossRefPubMed Stockbrugger RW, Schoon EJ, Bollani S, et al. Discordance between the degree of osteopenia and the prevalence of spontaneous vertebral fractures in Crohn’s disease. Aliment Pharmacol Ther. 2002;16:1519–1527.CrossRefPubMed
27.
Zurück zum Zitat Bernstein CN. Limiting fracture risk in Crohn’s disease: is there anything better than calcium and vitamin D? Clin Gastroenterol Hepatol. 2005;3:110–112.CrossRefPubMed Bernstein CN. Limiting fracture risk in Crohn’s disease: is there anything better than calcium and vitamin D? Clin Gastroenterol Hepatol. 2005;3:110–112.CrossRefPubMed
28.
Zurück zum Zitat Bernstein CN, Blanchard JF, Metge C, Yogendran M. The association between corticosteroid use and development of fractures among IBD patients in a population-based database. Am J Gastroenterol. 2003;98:1797–1801.CrossRefPubMed Bernstein CN, Blanchard JF, Metge C, Yogendran M. The association between corticosteroid use and development of fractures among IBD patients in a population-based database. Am J Gastroenterol. 2003;98:1797–1801.CrossRefPubMed
29.
Zurück zum Zitat de Jong DJ, Corstens FH, Mannaerts L, van Rossum LG, Naber AH. Corticosteroid-induced osteoporosis: does it occur in patients with Crohn’s disease? Am J Gastroenterol. 2002;97:2011–2015.CrossRefPubMed de Jong DJ, Corstens FH, Mannaerts L, van Rossum LG, Naber AH. Corticosteroid-induced osteoporosis: does it occur in patients with Crohn’s disease? Am J Gastroenterol. 2002;97:2011–2015.CrossRefPubMed
30.
Zurück zum Zitat Wagnon JH, Leiman DA, Ayers GD, Schwartz DA. Survey of gastroenterologists’ awareness and implementation of AGA guidelines on osteoporosis in inflammatory bowel disease patients: are the guidelines being used and what are the barriers to their use? Inflamm Bowel Dis. 2009;15:1082–1089.CrossRefPubMed Wagnon JH, Leiman DA, Ayers GD, Schwartz DA. Survey of gastroenterologists’ awareness and implementation of AGA guidelines on osteoporosis in inflammatory bowel disease patients: are the guidelines being used and what are the barriers to their use? Inflamm Bowel Dis. 2009;15:1082–1089.CrossRefPubMed
Metadaten
Titel
Fracture-Associated Hospitalizations in Patients with Inflammatory Bowel Disease
verfasst von
Ashwin N. Ananthakrishnan
Emily L. McGinley
David G. Binion
Kia Saeian
Publikationsdatum
01.01.2011
Verlag
Springer US
Erschienen in
Digestive Diseases and Sciences / Ausgabe 1/2011
Print ISSN: 0163-2116
Elektronische ISSN: 1573-2568
DOI
https://doi.org/10.1007/s10620-010-1433-9

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