Long-term fracture risk in patients with Crohn's disease: A population-based study in Olmsted County, Minnesota

Edward Vincent Loftus, Jr, Cynthia Crowson, William J. Sandborn, William J. Tremaine, William M. O'Fallon, L. Joseph Melton

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Abstract

Background & Aims: Osteoporosis is common in patients with Crohn's disease, but less is known about their risk of actual fractures. Methods: The medical records of all 238 Olmsted County, Minnesota, residents diagnosed with Crohn's disease between 1940 and 1993 were reviewed for evidence of subsequent fractures compared with a control group of county residents matched by age and sex. The risk ratio of fracture in patients relative to controls was estimated using the Cox proportional hazards regression model. The cumulative incidence of fracture following diagnosis was estimated using the Kaplan-Meier method. Results: Sixty-three patients had 117 different fractures. The cumulative incidence of any fracture from the time of diagnosis onward was 36% at 20 years versus 32% in controls (P = 0.792). Compared with controls, the overall risk ratio for any fracture was 0.9 (95% confidence interval [Cl], 0.61.4), whereas the relative risk for an osteoporotic fracture was 1.4 (95% Cl, 0.7-2.7). The risk ratio for thoracolumbar vertebral fracture was 2.2 (95% Cl, 0.9-5.5). Cox proportional hazards regression identified only age as a significant clinical predictor of fracture risk (hazard ratio per 10-year increase in age, 1.3; 95% Cl, 1.1-1.5). Specifically, use of corticosteroids and surgical resection did not predict risk of fracture among these unselected patients with Crohn's disease from the community. Conclusions: In this population-based inception cohort of patients with Crohn's disease, the risk of fracture was not elevated relative to age- and sex-matched controls.

Original languageEnglish (US)
Pages (from-to)468-475
Number of pages8
JournalGastroenterology
Volume123
Issue number2
DOIs
StatePublished - 2002

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Crohn Disease
Odds Ratio
Population
Osteoporotic Fractures
Incidence
Proportional Hazards Models
Osteoporosis
Medical Records
Adrenal Cortex Hormones
Confidence Intervals
Control Groups

ASJC Scopus subject areas

  • Gastroenterology

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Long-term fracture risk in patients with Crohn's disease : A population-based study in Olmsted County, Minnesota. / Loftus, Jr, Edward Vincent; Crowson, Cynthia; Sandborn, William J.; Tremaine, William J.; O'Fallon, William M.; Melton, L. Joseph.

In: Gastroenterology, Vol. 123, No. 2, 2002, p. 468-475.

Research output: Contribution to journalArticle

Loftus, Jr, Edward Vincent ; Crowson, Cynthia ; Sandborn, William J. ; Tremaine, William J. ; O'Fallon, William M. ; Melton, L. Joseph. / Long-term fracture risk in patients with Crohn's disease : A population-based study in Olmsted County, Minnesota. In: Gastroenterology. 2002 ; Vol. 123, No. 2. pp. 468-475.
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N2 - Background & Aims: Osteoporosis is common in patients with Crohn's disease, but less is known about their risk of actual fractures. Methods: The medical records of all 238 Olmsted County, Minnesota, residents diagnosed with Crohn's disease between 1940 and 1993 were reviewed for evidence of subsequent fractures compared with a control group of county residents matched by age and sex. The risk ratio of fracture in patients relative to controls was estimated using the Cox proportional hazards regression model. The cumulative incidence of fracture following diagnosis was estimated using the Kaplan-Meier method. Results: Sixty-three patients had 117 different fractures. The cumulative incidence of any fracture from the time of diagnosis onward was 36% at 20 years versus 32% in controls (P = 0.792). Compared with controls, the overall risk ratio for any fracture was 0.9 (95% confidence interval [Cl], 0.61.4), whereas the relative risk for an osteoporotic fracture was 1.4 (95% Cl, 0.7-2.7). The risk ratio for thoracolumbar vertebral fracture was 2.2 (95% Cl, 0.9-5.5). Cox proportional hazards regression identified only age as a significant clinical predictor of fracture risk (hazard ratio per 10-year increase in age, 1.3; 95% Cl, 1.1-1.5). Specifically, use of corticosteroids and surgical resection did not predict risk of fracture among these unselected patients with Crohn's disease from the community. Conclusions: In this population-based inception cohort of patients with Crohn's disease, the risk of fracture was not elevated relative to age- and sex-matched controls.

AB - Background & Aims: Osteoporosis is common in patients with Crohn's disease, but less is known about their risk of actual fractures. Methods: The medical records of all 238 Olmsted County, Minnesota, residents diagnosed with Crohn's disease between 1940 and 1993 were reviewed for evidence of subsequent fractures compared with a control group of county residents matched by age and sex. The risk ratio of fracture in patients relative to controls was estimated using the Cox proportional hazards regression model. The cumulative incidence of fracture following diagnosis was estimated using the Kaplan-Meier method. Results: Sixty-three patients had 117 different fractures. The cumulative incidence of any fracture from the time of diagnosis onward was 36% at 20 years versus 32% in controls (P = 0.792). Compared with controls, the overall risk ratio for any fracture was 0.9 (95% confidence interval [Cl], 0.61.4), whereas the relative risk for an osteoporotic fracture was 1.4 (95% Cl, 0.7-2.7). The risk ratio for thoracolumbar vertebral fracture was 2.2 (95% Cl, 0.9-5.5). Cox proportional hazards regression identified only age as a significant clinical predictor of fracture risk (hazard ratio per 10-year increase in age, 1.3; 95% Cl, 1.1-1.5). Specifically, use of corticosteroids and surgical resection did not predict risk of fracture among these unselected patients with Crohn's disease from the community. Conclusions: In this population-based inception cohort of patients with Crohn's disease, the risk of fracture was not elevated relative to age- and sex-matched controls.

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