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. 2020 Nov 26;21(1):779.
doi: 10.1186/s12891-020-03811-3.

Hepatic encephalopathy increases the risk of hip fracture: a nationwide cohort study

Kuang-Ting Yeh  1   2 , Tzai-Chiu Yu  1   2 , Ru-Ping Lee  3 , Jen-Hung Wang  4 , Kuan-Lin Liu  1   2 , Cheng-Huan Peng  1 , Hao-Wen Chen  1 , Ing-Ho Chen  1   2 , Chung-Yi Hsu  5 , Wen-Tien Wu  6   7   8
Affiliations

Hepatic encephalopathy increases the risk of hip fracture: a nationwide cohort study

Kuang-Ting Yeh et al. BMC Musculoskelet Disord. .

Abstract

Background: Osteoporotic hip fracture is a common general health problem with a significant impact on human life because it debilitates the patients and largely decreases their quality of life. Early prevention of fractures has become essential in recent decades. This can be achieved by evaluating the related risk factors, as a reference for further intervention. This is especially useful for the vulnerable patient group with comorbidities. Hepatic encephalopathy (HE), a major complication of liver cirrhosis, may increase the rate of falls and weaken the bone. This study evaluated the correlation between hepatic encephalopathy and osteoporotic hip fracture in the aged population using a national database.

Methods: This retrospective cohort study used data from Taiwan's National Health Insurance Research Database between 2000 and 2012. We included people who were older than 50 years with hepatic encephalopathy or other common chronic illnesses. Patients with and without hepatic encephalopathy were matched at a ratio of 1:4 for age, sex, and index year. The incidence and hazard ratios of osteoporotic hip fracture between the both cohorts were calculated using Cox proportional hazard regression models.

Results: The mean age of the enrolled patients was 66.5 years. The incidence ratio of osteoporotic hip fracture in the HE group was significantly higher than that in the non-HE group (68/2496 [2.7%] vs 98/9984 [0.98%]). Patients with HE were 2.15-times more likely to develop osteoporotic hip fractures than patients without HE in the whole group. The risk ratio was also significantly higher in female and older individuals. The results were also similar in the comorbidity subgroups of hypertension, diabetes mellitus, hyperlipidemia, senile cataract, gastric ulcer, and depression. Alcohol-related illnesses seemed to not confound the results of this study.

Conclusions: HE is significantly associated with an increased risk of osteoporotic hip fractures, and the significance is not affected by the comorbidities in people aged more than 50 years. The cumulative risk of fracture increases with age.

Keywords: Hepatic encephalopathy; Kaplan–Meier method; Nationwide cohort study; Osteoporotic hip fracture; Propensity score.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Flow chart of the process for establishing the hepatic encephalopathy cohort and control group on the basis of the National Health Insurance Research Database
Fig. 2
Fig. 2
Cumulative incidence of osteoporotic hip fractures of patients with and without hepatic encephalopathy
See this image and copyright information in PMC

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