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Osteoporotic Fracture Risk and Health Care Burden in Patients With Cirrhosis

Patel, Arpan MD*,†; Silverman, Stuart MD; Baghdadi, Jonathan MD†,§; Shah, Omer MD; Sundaram, Vinay MD, MS¶,#

Journal of Clinical Gastroenterology: August 2019 - Volume 53 - Issue 7 - p 543–548
doi: 10.1097/MCG.0000000000001105
LIVER, PANCREAS & BILIARY TRACT: Original Articles
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Background and Aims: Risk factors for osteoporotic fracture as well as inpatient utilization and mortality have not been thoroughly studied in patients with cirrhosis. We analyzed data from a national database to determine fracture risk in patients with cirrhosis, specific risk factors, and the effect of fractures on health care utilization.

Methods: We performed an observational study using serial cross-sectional data to examine fracture-related hospitalizations of patients with cirrhosis using the National Inpatient Sample from 2012 to 2013. We collected data on fracture-related hospitalizations and utilization in the form of length of stay (LOS), total hospital costs, and inpatient mortality. We used multivariate regression to determine risk factors for fracture and fracture-related mortality.

Results: Patients with cirrhosis and an osteoporotic fracture had a mean LOS of 10.4 days and incurred $26,582 per hospitalization, which were statistically different from noncirrhotic patients with fracture (LOS: 6.60 d, cost: $17,918) and cirrhotic patients without fracture (LOS: 7.84 d, $18,912). Malnutrition was associated with increased odds of fracture [odds ratio (OR), 1.29; 95% confidence interval (CI), 1.20-1.39] and inpatient mortality (OR, 1.40; 95% CI, 1.12-1.76). Obesity was protective against both fracture (OR, 0.78; 95% CI, 0.71-0.85) and fracture-related mortality (OR, 0.82; 95% CI, 0.59-1.14).

Conclusions: Hospitalizations for osteoporotic fractures in patients with cirrhosis are a significant source of health care burden and mortality. More attention should be paid to screening patients with cirrhosis for low bone mass. Malnutrition is associated with increased fracture risk and fracture-related mortality, representing a modifiable risk factor worthy of addressing in patients with cirrhosis.

*Division of Digestive Diseases

Division of General Internal Medicine and Health Services Research

§Division of Infectious Diseases, University of California

Departments of Medicine

Gastroenterology

Bone Health Center

#Comprehensive Transplant Center, Cedars-Sinai Medical Center, Los angeles, CA

Supported by the Ruth L. Kirschstein Institutional National Research Service Award (NRSA) for Primary Care T32 (T32HP19001) and The Specialty Training and Advanced Research (STAR) Program at University of California, Los Angeles (A.P. and J.B.).

A.P.: drafting of manuscript. S.S. and V.S.: study supervision. A.P., J.B., S.S., and V.S.: statistical analysis.

The authors declare that they have nothing to disclose.

Address correspondence to: Arpan Patel, MD, Division of Digestive Diseases, David Geffen School of Medicine at University of California, 10945 Le Conte Avenue, PVUB 2114, MC 694907, Los Angeles, CA 90095-6949 (e-mail: arpanpatel@mednet.ucla.edu).

Received February 20, 2018

Accepted June 23, 2018

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