Journal
JOURNAL OF INTERNAL MEDICINE
Volume 292, Issue 3, Pages 492-500Publisher
WILEY
DOI: 10.1111/joim.13497
Keywords
epidemiology; liver disease; metabolic dysfunction-associated fatty liver disease; non-alcoholic steatohepatitis; osteoporosis
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Funding
- Syskonen Svensson Foundation
- Region Stockholm
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Patients with non-alcoholic fatty liver disease (NAFLD) have a slightly higher risk of fractures, but their long-term risk of fractures is comparable to the general population. This suggests that broad surveillance of risk factors for fractures in patients with NAFLD is not necessary.
Background Studies suggest an association between osteoporosis and non-alcoholic fatty liver disease (NAFLD), but whether patients with NAFLD are at increased risk of fractures is unknown. Objectives The aim was to determine the rate and risk of fractures and the mortality rate after fracture in patients with NAFLD compared to the general population. Methods This was a nationwide population-based cohort study using data from the Swedish National Patient Registry on 10,678 patients with NAFLD from 1987 to 2016. Patients were matched for sex, age, and municipality with 99,176 controls from the Swedish Total Population Registry. Cox regression was used to estimate fracture rates. The risk of fractures was assessed while accounting for competing risks (death and liver transplantation). Results A total of 12,312 fractures occurred during 761,176 person-years of follow-up. Patients with NAFLD (17.5 per 1000 person-years) had a slightly higher fracture rate than controls (16.1 per 1000 person-years; adjusted hazard ratio 1.11, 95% confidence interval [CI] 1.05-1.19), although the 5-year risk of fractures was similar (8.0%, 95% CI 7.4-8.6 versus 7.3%, 95% CI 7.2-7.5). Additionally, 1-year mortality after fracture was similar in NAFLD and controls. Conclusions Patients with NAFLD have a slightly higher rate of fractures but long-term risk of fractures comparable to the general population. This suggests that broad surveillance of risk factors for fractures in patients with NAFLD is not motivated.
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