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Increased incidence of orthopedic fractures in cirrhotic patients

The latest Journal of Hepatology reports an increased incidence of orthopedic fractures in cirrhotic patients.

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Hepatic encephalopathy is a reversible neuropsychiatric disorder in cirrhotic patients.

The cognitive dysfunction and increased accidental falls in hepatic encephalopathy and osteodystrophy in cirrhotic patients may contribute to orthopedic fractures.

Dr Chia-Fen Tsai from Taiwan reported that this study investigated the fracture incidence and risk factors in cirrhotic patients with hepatic encephalopathy.

In total, 3764 cirrhotic patients with Hepatic encephalopathy were identified from the Taiwan National Health Insurance database between 2000 and 2009.

The research team assessed that the fracture incidence of the hepatic encephalopathy patients was compared with that of 3764 age-, sex-, and comorbidity-matched cirrhotic patients without hepatic encephalopathy and non-cirrhotic controls.

Cox proportional hazard models were used to estimate the risk of fracture in the Hepatic encephalopathy patients.

The estimated fracture rates were 7% for the hepatic encephalopathy group
Journal of Hepatology

The doctors noted that cirrhotic patients with and without hepatic encephalopathy had comparable increased risks of fracture, and cumulative incidences of fracture than controls.

The estimated fracture rates were 7% for the hepatic encephalopathy group, 7.7% for the cirrhosis without hepatic encephalopathy group, and 4% for the controls, during the 18-month follow-up.

The researchers assessed that the hepatic encephalopathy group had a higher incidence rate of skull fractures, but a lower rate of upper limb fractures than the cirrhosis without hepatic encephalopathy group.

Alcoholism, heart failure, and cerebrovascular disease were associated with increased risk of fracture in hepatic encephalopathy patients.

Dr Tsai's team concluded, "Cirrhotic patients, with or without hepatic encephalopathy are at an increased risk of orthopedic fractures."

"Skull fractures, rather than fractures in weight-bearing bones, are more frequently observed in Hepatic encephalopathy patients, particularly those with comorbidities."

J Hepatol 2013: 58(4): 706-714
17 April 2013

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