The Incidence of Fracture among Patients with Inflammatory Bowel Disease: A Population-Based Cohort Study

  1. Charles N. Bernstein, MD;
  2. James F. Blanchard, MD, PhD;
  3. William Leslie, MD;
  4. Andre Wajda, MS; and
  5. B. Nancy Yu, MS, PhD
  1. From University of Manitoba and Manitoba Health, Winnipeg, Manitoba, Canada.

    Abstract

    Background: The clinical significance of the high prevalence of osteopenia in inflammatory bowel disease is unclear.

    Objective: To determine whether persons with inflammatory bowel disease have increased incidence of fracture.

    Design: Population-based matched cohort study.

    Setting: Manitoba, Canada.

    Patients: Patients with inflammatory bowel disease in the University of Manitoba IBD Database (n = 6027) were matched to 10 randomly selected persons in the general population without inflammatory bowel disease (n = 60 270) by year, age, sex, and postal area of residence.

    Measurements: The incidence of hospitalization for hip fracture was determined on the basis of hospital discharge abstracts. Outpatient medical billing records and hospital discharge abstracts were used to calculate the incidence of spine, rib, and forearm fractures. Rates were calculated on the basis of person-years of follow-up for 1984 to 1997.

    Results: Persons with inflammatory bowel disease had significantly increased incidence of fractures at the spine (incidence rate ratio [IRR], 1.74 [95% CI, 1.34 to 2.24]; P < 0.001), hip (IRR, 1.59 [CI, 1.27 to 2.00]; P < 0.001), wrist/forearm (IRR, 1.33 [CI, 1.11 to 1.58]; P = 0.001), and rib (IRR, 1.25 [CI, 1.02 to 1.52]; P = 0.03) and of any of these fractures (IRR, 1.41 [CI, 1.27 to 1.56]; P < 0.001).

    Conclusion: The incidence of fracture among persons with inflammatory bowel disease is 40% greater than that in the general population.

    Article and Author Information

    • Grant Support: Dr. Bernstein is supported by the Manitoba Medical Services Foundation Clinical Professorship Scholarship.

    • Requests for Single Reprints: Charles N. Bernstein, MD, Section of Gastroenterology, University of Manitoba, 804F-715 McDermot Avenue, John Buhler Research Centre, Winnipeg, Manitoba R3E 3P4, Canada; e-mail, cbernst{at}cc.umanitoba.ca.

    • Current Author Addresses: Dr. Bernstein: Section of Gastroenterology, University of Manitoba, 804F-715 McDermot Avenue, John Buhler Research Centre, Winnipeg, Manitoba R3E 3P4, Canada.

    • Dr. Blanchard: Community Health Sciences, 750 Bannatyne Avenue, Winnipeg, Manitoba R3E 0W3, Canada.

    • Dr. Leslie: Saint Boniface General Hospital, 400 Tache Avenue, Winnipeg, Manitoba R2H 2A6, Canada.

    • Mr. Wajda and Dr. Yu: Manitoba Epidemiology Unit, 300 Carleton Street, Winnipeg, Manitoba R3B 3M9, Canada.

    • Author Contributions: Conception and design: C.N. Bernstein, J.F. Blanchard, W. Leslie, A. Wajda.

    • Analysis and interpretation of the data: C.N. Bernstein, J.F. Blanchard, A. Wajda, B.N. Yu.

    • Drafting of the article: C.N. Bernstein.

    • Critical revision of the article for important intellectual content: C.N. Bernstein, J.F. Blanchard, W. Leslie.

    • Final approval of the article: C.N. Bernstein, J.F. Blanchard, W. Leslie, A. Wajda, B.N. Yu.

    • Statistical expertise: C.N. Bernstein, J.F. Blanchard, A. Wajda, B.N. Yu.

    • Administrative, technical, or logistic support: C.N. Bernstein.

    • Collection and assembly of data: C.N. Bernstein, J.F. Blanchard, A. Wajda, B.N. Yu.

    Summary for Patients

    • Summaries for Patients:Bone Fractures in Patients with Inflammatory Bowel Disease Ann Intern Med November 21, 2000 133:S-54
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    1. Ann Intern Med November 21, 2000 vol. 133 no. 10 795-799
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