Hip fracture patients who have cirrhosis of the liver are at greater risk of complications and infections, according to a new study.
Cirrhosis Increases Complication for Hip Fractures
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#hipfracture#osteoporosisSecondary#livercirrhosis
In the study, “Increased incidence, morbidity and mortality in cirrhotic patients with hip fractures: A nationwide population-based study,” published online on August 12, 2020 in the Journal of Orthopaedic Surgery, the researchers investigated the prevalence, complication and mortality rates related to hip fractures in patients with liver cirrhosis.
The parenchyma is the functional tissue of the liver. Liver cirrhosis occurs when the parenchyma develops a nodular form of fibrosis due to chronic liver damage. Previous studies have shown that liver disease may lead to a bone disease called hepatic osteodystrophy, of which osteoporosis is the most common.
Using the Taiwan National Health Insurance Research Database, the researchers enrolled 117,129 patients with hip fractures, including 4,048 patients with cirrhosis. All the patients were diagnosed between 2004 and 2010. Outcomes in the cirrhosis group were compared to those in the general group.
Those patients in the cirrhosis group were younger than those in the general group (71.2 vs. 73.96 years, p < 0.001). Overall, the annual incidence of hip fractures in the cirrhosis and general groups was 46-54 and 7-7.5 per 10,000 person-years, respectively.
The rates of infection, urinary tract infection, and peptic ulcer disease were higher in the cirrhosis group (3.46% vs. 1.91%, 9.56% vs. 9.11%, and 8.05% vs. 3.55%, respectively, all p < 0.001). The mortality rate after hip fracture was also higher in the cirrhosis group than in the general group (within 3 months: 8.76-12.64% vs. 4.96-29.72-37.99% vs. 12.84-14.57%).
The researchers wrote, “Cirrhotic patients with hip fractures were relatively younger; had a seven times higher annual hip fracture incidence; had higher complication rates of infection, urinary tract infection, and peptic ulcer disease; and had two to three times higher a mortality rate at 3 months and 1 year.”
They added that clinicians should be aware of the possibility of osteoporosis and hip fracture in patients with liver cirrhosis.
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This is a fascinating development. In my practice we've seen similar outcomes with the revised protocol. The key differentiator seems to be patient selection criteria. Has anyone else noticed the correlation with BMI thresholds?
Great point. I'd push back slightly on the conclusion, the sample size in the cited study is too small to draw population-level inferences. That said, the directional signal is compelling and worth a larger RCT.
We implemented a similar approach last year. Early results are promising but we're still gathering 12-month follow-up data. Happy to share our protocol if anyone is interested.
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