1070 Hip Fractures in Celiac Disease Patients: A Nationwide Analysis

Abstract

INTRODUCTION: Autoimmunity associated with Celiac disease (CD) has previously shown to be associated with bone health and hip fracture risk. Literature also supports supplementation of Vitamin D in celiac disease patients to increase bone mineral density. Currently, there is no US national-level study to show the risk of hip fractures in CD patients. METHODS: We conducted a cross-sectional study using the National Inpatient Sample (2008 to 2014). We identified patients with a primary diagnosis of HP using diagnosis codes for the neck of femur, intertrochanteric and subtrochanteric fractures or procedure codes for interventions for hip fractures including total hip replacement. The primary outcome was the total number of hospitalizations with secondary outcomes including mortality, length of stay (LOS) and total hospitalization charges. We adjusted outcomes for confounding factors such as age, gender, race, and comorbidities by the univariate and multivariate regression model. RESULTS: From 2008-2012, a total of 32,96,442 hospitalizations were identified for hip fractures, of which 3614 (0.1%) had associated celiac disease. CD subgroup had significantly increased number of females, Caucasians, and elderly patients but no differences were noted in the total number of comorbidities. CD + HP was more common in hospitals situated in the northeastern states than only HP group but there were no differences noted in the teaching vs nonteaching hospitals or urban vs rural hospitals. Multivariate analysis with confounding factors showed that patients with CD were more likely to have HP with OR 1.08 (95%CI: 1.003-1.18; P = 0.041). There was no significant difference in mortality or mean length of stay. Patients with CD and hip fractures had higher incidence and odds ratio of osteoporosis than non-CD patients (29% vs 13.1%, OR: 3.71, P = 0.00). CONCLUSION: Our study showed that patients with CD are more likely to get hip fractures which is further supported by increased prevalence of osteoporosis in these patients. However, there is no difference in terms of in-hospital mortality and hospital resources utilization in comparison to patients without CD. Our study reinforces the necessity of addressing risk of osteoporosis risk in CD patients with Vitamin D and calcium supplementation, which can likely prevent a gravely morbid event like a hip fracture.