Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2004 Feb;53(2):251-5.
doi: 10.1136/gut.2003.026799.

Hip fractures in patients with inflammatory bowel disease and their relationship to corticosteroid use: a population based cohort study

T Card  1 , J West, R Hubbard, R F A Logan
Affiliations

Hip fractures in patients with inflammatory bowel disease and their relationship to corticosteroid use: a population based cohort study

T Card et al. Gut. 2004 Feb.

Abstract

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.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Hip fracture rated per 10 000 person years in males (A) and females (B), by age group.
See this image and copyright information in PMC

Comment in

References

    1. Bernstein CN, Seeger LL, Sayre JW, et al. Decreased bone density in inflammatory bowel disease is related to corticosteroid use and not disease diagnosis. J Bone Miner Res 1995;10:250–6. - PubMed
    1. Jahnsen J, Falch JA, Mowinckel P, et al. Vitamin D status, parathyroid hormone and bone mineral density in patients with inflammatory bowel disease. Scand J Gastroenterol 2002;37:192–9. - PubMed
    1. Compston JE, Judd D, Crawley EO, et al. Osteoporosis in patients with inflammatory bowel disease. Gut 1987;28:410–15. - PMC - PubMed
    1. Jahnsen J, Falch JA, Aadland E, et al. Bone mineral density is reduced in patients with Crohn’s disease but not in patients with ulcerative colitis: a population based study. Gut 1997;40:313–19. - PMC - PubMed
    1. Silvennoinen JA, Karttunen TJ, Niemela SE, et al. A controlled study of bone mineral density in patients with inflammatory bowel disease. Gut 1995;37:71–6. - PMC - PubMed

Publication types

MeSH terms