Fracture-Associated Hospitalizations in Patients with Inflammatory Bowel Disease

Abstract

Maintenance of bone health is an important concern in patients with inflammatory bowel disease (IBD). They may frequently have impaired bone density resulting in greater incidence of fractures. To examine fracture-associated hospitalization costs in IBD patients from a nationwide representative sample, and to compare the risk factors for such fractures in IBD and non-IBD patients. We identified discharges with IBD and coexisting codes for hip, vertebral or wrist fractures (IBD-Fr) from the Nationwide Inpatient Sample and compared them with IBD hospitalizations without codes for these fractures. A second analysis was performed using 2008 inpatient data from the Wisconsin Hospital Association (WHA) comparing characteristics of patients with IBD-Fr and non-IBD controls hospitalized for similar fractures. There were 1,653 discharges in the IBD-Fr group accounting for 10,461 days of hospital stay and US $46 million in total hospitalization charges. On multivariate analysis, age>65 years [odds ratio (OR) 28.8, 95% confidence interval (CI) 12.3-67.6] and female sex (OR 1.3, 95%CI 1.0-1.6) were associated with higher odds of hospitalization associated with fractures. We found no differences in age, gender, or race among IBD-Fr and non-IBD fracture controls. However, IBD-fractures were twice as likely to be associated with osteoporosis as non-IBD fractures (OR 2.19, 95%CI 1.10-4.33). Older age, female sex, and osteoporosis were more commonly associated with hospitalization for fractures in IBD patients. Osteoporosis appears to be more common among IBD-Fr patients than non-IBD fracture controls.