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Post-surgery cholecystectomy, hepatectomy, and pancreatectomy patients increase the risk of osteoporotic vertebral fracture

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Abstract

Introduction

Data is currently lacking regarding association between the cholecystectomy/hepatectomy/pancreatectomy and the development of osteoporotic fracture. A retrospective cohort study was conducted to investigate the relationship between cholecystectomy/hepatectomy/pancreatectomy and the subsequent risk of developing osteoporotic fracture.

Materials and Methods

Patients having undergone cholecystectomy, hepatectomy, or pancreatectomy between 2000 and 2012 were selected from the All Population Based Hospitalization File as the surgery cohort (n = 304,081), which was frequency matched with the control cohort (n = 304,081). The Cox proportional hazard model and Kaplan–Meier analysis were applied to measure the hazard ratios and the cumulative incidence of osteoporotic fracture.

Results

A total of 1136 patients in the surgery cohort and 1179 patients in the control cohort were newly diagnosed with osteoporotic fracture. The overall osteoporotic fracture risk in the surgery cohort was 1.12-fold higher [95% confidence interval (CI), 1.03–1.21]. Specifically, surgery cohort had higher vertebral fracture risk than non-surgery cohort [adjusted hazard ratio (aHR) 1.12, Cl, 1.03–1.22]. In addition, patients underwent cholecystectomy (includes open and laparoscopic approaches), hepatectomy (only open approach), and pancreatectomy group (only open approach) were 1.10 (95% CI, 1.01–1.19), 1.49 (95% CI, 1.10–2.01), and 1.88 (95% CI, 1.23–2.87) times more likely to develop osteoporotic fracture, respectively. No significant difference of osteoporotic fracture risk was observed between open and laparoscopic cholecystectomy. The risk of osteoporotic fracture was significantly increased in females, patients aged ≥ 40 years old, and patients with some comorbidity.

Conclusions

Patients post cholecystectomy, hepatectomy, or pancreatectomy significantly increased risk of developing osteoporotic fracture, suggesting closer attention in post-operative care is needed.

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Abbreviations

aHR:

Adjusted hazard ratio

BMD:

Bone mineral density

CAD:

Coronary artery disease

CIs:

Confidence intervals

DXA:

Dual-energy X-ray absorptiometry

CKD:

Chronic kidney disease

COPD:

Chronic obstructive pulmonary disease

HRs:

Hazard ratios

ICD-9-CM:

International Classification of Diseases, 9th Revision, Clinical Modification

NHI:

National Health Insurance

NHIRD:

National Health Insurance Research Database

25-OH vitamin D:

25-Hydroxy vitamin D

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Acknowledgements

The authors would like to thank James Waddell of Concise Language Services for the critical reading and revision of our manuscript.

Funding

This work was supported and funded by the Ministry of Science and Technology of Taiwan (MOST 108–2320-B-039–022), Health and Welfare Surcharge of Tobacco Products, China Medical University Hospital Cancer Research Center of Excellence (MOHW108-TDU-B-212–124024), China Medical University Hospital (DMR-108–007, DMR-108–009, DMR-108–044 and CRS-108–001), An-Nan Hospital, China Medical University (ANHRF-108–06 and ANHRF-108–08) and the Chinese Medicine Research Center, China Medical University, under the Higher Education Sprout Project, Ministry of Education (CMRC-CHM-1) in Taiwan. This work was also supported by grants from the Ministry of Health and Welfare, Taiwan (MOHW107-TDU-B-212–123004), China Medical University Hospital, Academia Sinica Stroke Biosignature Project (BM10701010021), MOST Clinical Trial Consortium for Stroke (MOST 107–2321-B-039 -004-), Tseng-Lien Lin Foundation, Taichung, Taiwan, and Katsuzo and Kiyo Aoshima Memorial Funds, Japan.

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Author notes

  1. Wei-Zen Cheng and Yun-Lan Lin contributed equally to this work.

Authors and Affiliations

  1. Department of Chinese Medicine, China Medical University Hospital, No. 2, Yude Road, North District, Taichung City, 40447, Taiwan

    Wei-Zen Cheng, Yun-Lan Lin & Sheng-Teng Huang

  2. Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan

    Yuan-Chih Su & Mei-Chen Lin

  3. Tainan Municipal An-Nan Hospital-China Medical University, No. 66, Section 2, Changhe Road, Annan District, Tainan city, 70965, Taiwan

    Chang-Hsing Tseng, Ruey-Mo Lin & Sheng-Teng Huang

  4. School of Chinese Medicine, China Medical University, Taichung, Taiwan

    Sheng-Teng Huang

  5. Chinese Medicine Research Center, China Medical University, Taichung, Taiwan

    Sheng-Teng Huang

  6. Research Center for Chinese Herbal Medicine, China Medical University, Taichung, Taiwan

    Sheng-Teng Huang

  7. Department of Medical Research, Cancer Research Center for Traditional Chinese Medicine, China Medical University Hospital, Taichung, Taiwan

    Sheng-Teng Huang

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Contributions

WZC and YLL wrote the manuscript and interpreted the data. YCS, MCL, and CHT collected, assembled, and analyzed the data. HRY and RML offered administrative support and corrected the manuscript. STH designed, conceived the study, and amended the manuscript. All of the authors approved the final manuscript.

Corresponding author

Correspondence to Sheng-Teng Huang.

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None declared.

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Our study was approved by the Research Ethics Committee of China Medical University and Hospital, Taichung, Taiwan (CMUH104-REC2-115(CR-2)). All of the datasets were de-identified from the NHIRD, so the review board waived the requirement to sign informed consent from patients.

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Cheng, WZ., Lin, YL., Su, YC. et al. Post-surgery cholecystectomy, hepatectomy, and pancreatectomy patients increase the risk of osteoporotic vertebral fracture. J Bone Miner Metab 39, 174–185 (2021). https://doi.org/10.1007/s00774-020-01129-7

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