Inflammation Predicts Increased Fracture Risk in IBD

TOPLINE:

A 12-month period of histological inflammation is linked to a modestly increased risk for fracture in patients with inflammatory bowel disease (IBD), with the most pronounced increase observed in patients who are also corticosteroid-naive.

METHODOLOGY:

• Although patients with IBD are known to have a heightened risk for fractures, it is unclear what role recent histological activity has in influencing this outcome.
• A nationwide cohort study of Swedish healthcare registers aimed to determine the risk for fracture in 54,591 individuals diagnosed with IBD from 1990 to 2016, during periods with histological inflammation vs histological remission. All patients underwent ileo-colorectal biopsies.
• The primary outcome was any fracture listed as a main or contributory diagnosis, with a secondary analysis limited to hip fractures alone.
• Researchers used Cox regression models to estimate hazard ratios for fractures over the 12 months following histological inflammation vs histological remission.

TAKEAWAY:

• Of all patients included, 43,449 (mean age, 44.0 years) contributed to 71,444 periods of histological inflammation, and 23,814 (mean age, 45.5 years) contributed to 34,192 periods of histological remission.
• There was a 12% increased risk for any fracture within the 12-month period of histological inflammation vs remission (P = .04).
• Histological inflammation was also associated with a modestly increased fracture risk in male patients with IBD (adjusted hazard ratio [aHR], 1.21) and in patients diagnosed with IBD within the previous 2 years (aHR, 1.33).
• The highest fracture risk was observed in corticosteroid-naive patients with histological inflammation, who had a 41% increased risk compared with those in histological remission.
• No significant association was found between histological inflammation and hip fracture risk (aHR, 1.29), primarily because the study population included young and middle-aged individuals.

IN PRACTICE:

“The study has highlighted inflammation as an independent, modifiable risk factor for fracture in IBD, as it is in rheumatological immune-mediated inflammatory diseases. It supports new ECCO [European Crohn’s and Colitis Organization] guidelines recommending screening for osteoporosis and adds to burgeoning evidence suggesting early intervention to reduce inflammation, rather than merely symptoms, improves health outcomes in IBD,” experts wrote in an accompanying editorial.

SOURCE:

The study, led by Karl Mårild, Department of Pediatrics, Queen Silvia Children’s Hospital, Gothenburg, Sweden, was published online in Alimentary Pharmacology & Therapeutics.

LIMITATIONS:

The study lacked data on changes in histological appearance over the 12 months following the last biopsy, which may have attenuated the difference between histological inflammation and remission. Some subanalyses lacked sufficient sample sizes to draw definitive conclusions on fracture risk across patient subgroups. Residual confounding from missing data on smoking, dietary habits, and physical activity may have influenced the findings. The study examined fractures requiring hospital care; therefore, the findings may not be applicable to fractures that did not receive clinical attention.

DISCLOSURES:

This study was supported by the University of Gothenburg, the Swedish Research Council, and other sources. Some authors received financial support, funding, research grants, or consultancy fees; served as advisory board members; or had other ties with several pharmaceutical companies.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.