IBD & fracture risk

November 26, 2024

Issue 23

Clinical Question

Is histological activity a factor for fracture risk in IBD?

Editor’s Bottom Line

Histologic inflammation is associated with an increased fracture risk among patients with IBD, even after correction for steroid use. The increase in risk may be driven by the inflammation itself.

Reference

Mårild K, Söderling J, Axelrad J, et al. A nationwide cohort study of inflammatory bowel disease, histological activity and fracture risk. Aliment Pharmacol Ther. Epub ahead of print Sept 23, 2024. https://onlinelibrary.wiley.com

Synopsis

Patients with IBD have a higher risk of fractures, although the reason for this association is unclear. To determine whether inflammation is associated with short-term fracture risk, researchers examined the Swedish ESPRESSO cohort database, which includes gastrointestinal histology reports up to 2016.

The investigators included records from 43,449 IBD patients with ileo-colorectal biopsies showing histological inflammation and 23,814 patients whose biopsies showed histological remission. They examined fracture risk in the 12 succeeding months.

The population was split roughly evenly by sex. Patients were a mean 44 to 45.5 years of age at the time of biopsy and most were 18–60 years of age. The mean age at time of diagnosis was 39 years of age and the mean disease duration at the time of biopsy was 4.3 and 6.4 years among those with or without histological activity, respectively.

Data showed that during the 12 months after biopsy, those with histological activity were 12% more likely to have a fracture (most commonly hip fractures) than those without histological activity (adjusted Hazard Ratio [aHR]: 1.12; 95% Confidence Interval [CI]: 1.0–1.26; p=0.04).

Specifically, the incidence of fractures during the 12 months after biopsy in the histologically active and inactive groups was 1.37 per 100 person-years and 1.31 per 100 person-years, respectively. The risk of fracture in the presence of histological activity persisted even in those with clinically quiescent IBD, the authors found, although the association fell short of statistical significance (aHR: 1.12; 95% CI: 0.94–1.33).

Further analysis showed that males with histological inflammation had a higher fracture risk than the general population (aHR: 1.21; 95% CI: 1.02–1.44) as did those diagnosed with IBD within the previous two years (aHR: 1.33; 95% CI: 1.09–1.62). The risk of fractures related to histologic activity remained consistent across age groups, education levels and IBD subtypes.

An analysis including only corticosteroid-naïve patients in the analysis found the risk of fracture was more pronounced after a biopsy showing histological inflammation vs. no inflammation (aHR: 1.41; 95% CI: 1.07–1.85).

 

Details

Study Design: Nationwide, register-based cohort study
Funding: The University of Gothenburg, ALF-funding from Region Västra Götaland, the Swedish Research Council, Karolinska Institutet, Region Stockholm, the Crohn’s and Colitis Foundation, the Judith Stewart Colton Center for Autoimmunity and the National Institutes of Health.
Allocation: Not applicable
Setting: Multicenter
Level of Evidence: 2b