Digestive Diseases and Sciences

, Volume 56, Issue 1, pp 176–182

Fracture-Associated Hospitalizations in Patients with Inflammatory Bowel Disease

  • Ashwin N. Ananthakrishnan
  • Emily L. McGinley
  • David G. Binion
  • Kia Saeian
Original Article

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.

Keywords

Inflammatory bowel disease Fractures Osteoporosis Nationwide Inpatient Sample Crohn’s disease Ulcerative colitis 

References

  1. 1.
    Moscandrew M, Mahadevan U, Kane S. General health maintenance in IBD. Inflamm Bowel Dis. 2009;15:1399–1409.CrossRefPubMedGoogle Scholar
  2. 2.
    Bernstein CN. Osteoporosis and other complications of inflammatory bowel disease. Curr Opin Gastroenterol. 2002;18:428–434.CrossRefPubMedGoogle Scholar
  3. 3.
    Bernstein CN. Osteoporosis in patients with inflammatory bowel disease. Clin Gastroenterol Hepatol. 2006;4:152–156.CrossRefPubMedGoogle Scholar
  4. 4.
    Bernstein CN, Leslie WD. Review article: Osteoporosis and inflammatory bowel disease. Aliment Pharmacol Ther. 2004;19:941–952.CrossRefPubMedGoogle Scholar
  5. 5.
    Bernstein CN, Leslie WD, Leboff MS. AGA technical review on osteoporosis in gastrointestinal diseases. Gastroenterology. 2003;124:795–841.CrossRefPubMedGoogle Scholar
  6. 6.
    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.CrossRefPubMedGoogle Scholar
  7. 7.
    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.CrossRefPubMedGoogle Scholar
  8. 8.
    Tilg H, Moschen AR, Kaser A, Pines A, Dotan I. Gut, inflammation and osteoporosis: Basic and clinical concepts. Gut. 2008;57:684–694.CrossRefPubMedGoogle Scholar
  9. 9.
    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.CrossRefPubMedGoogle Scholar
  10. 10.
    Redlich K, Hayer S, Ricci R, et al. Osteoclasts are essential for TNF-alpha-mediated joint destruction. J Clin Invest. 2002;110:1419–1427.PubMedGoogle Scholar
  11. 11.
    Wei S, Kitaura H, Zhou P, Ross FP, Teitelbaum SL. IL-1 mediates TNF-induced osteoclastogenesis. J Clin Invest. 2005;115:282–290.PubMedGoogle Scholar
  12. 12.
    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.PubMedGoogle Scholar
  13. 13.
    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.CrossRefPubMedGoogle Scholar
  14. 14.
    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.CrossRefPubMedGoogle Scholar
  15. 15.
    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.CrossRefPubMedGoogle Scholar
  16. 16.
    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.CrossRefPubMedGoogle Scholar
  17. 17.
    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.CrossRefPubMedGoogle Scholar
  18. 18.
    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.CrossRefPubMedGoogle Scholar
  19. 19.
    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.CrossRefPubMedGoogle Scholar
  20. 20.
    HCUP Nationwide Inpatient Sample (NIS). Healthcare Cost and Utilization Project (HCUP). Agency for Healthcare Research and Quality, Rockville, MD. www.hcup-us.ahrq.gov/nisoverview.jsp; 2004. Accessed 23.12.2007.
  21. 21.
    Whalen D, Houchens R, Elixhauser A HCUP Nationwide Inpatient Sample (NIS) Comparison Report. HCUP Methods Series Report # 2007-03 Online February 2, 2007. US Agency for Healthcare Research and Quality. Available from http://www.hcup-us.ahrq.gov/reports/methods.jsp; 2004.
  22. 22.
    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.CrossRefPubMedGoogle Scholar
  23. 23.
    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.CrossRefPubMedGoogle Scholar
  24. 24.
    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.CrossRefPubMedGoogle Scholar
  25. 25.
    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.CrossRefPubMedGoogle Scholar
  26. 26.
    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.CrossRefPubMedGoogle Scholar
  27. 27.
    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.CrossRefPubMedGoogle Scholar
  28. 28.
    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.CrossRefPubMedGoogle Scholar
  29. 29.
    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.CrossRefPubMedGoogle Scholar
  30. 30.
    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.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  • Ashwin N. Ananthakrishnan
    • 1
  • Emily L. McGinley
    • 2
  • David G. Binion
    • 3
  • Kia Saeian
    • 4
  1. 1.Gastrointestinal UnitMassachusetts General HospitalBostonUSA
  2. 2.Division of EpidemiologyMedical College of WisconsinMilwaukeeUSA
  3. 3.Division of Gastroenterology, Hepatology and NutritionUniversity of Pittsburgh School of MedicinePittsburghUSA
  4. 4.Division of Gastroenterology and HepatologyMedical College of WisconsinMilwaukeeUSA

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