Hepatic Encephalopathy Increases the Risk of Hip Fracture: a Nationwide Cohort Study

Background: Osteoporotic hip fracture is a common general health problem with significant impact of human life because it debilitates the patients and largely decrease their life quality. Early prevention of the fracture is essential in the recent decades by finding out the related risk factors as reference of further intervention, especially for the vulnerable patient group with comorbidities. Hepatic encephalopathy, a major complication of liver cirrhosis, may increase the rate of falling down and weaken the bone quality. This paper is aimed to finding out the correlation between hepatic encephalopathy and osteoporotic hip fracture in the aged patients from our national population.Methods: This retrospective cohort study used data from Taiwan’s National Health Insurance Research Database between 2000 and 2012. We focus on people who were older than 50 years old, using hepatic encephalopathy as compare grouping accordance, and finding the influence of the other common chronic illness. Patients with and without hepatic encephalopathy were matched at a ratio of 1:4 for age, sex, and index year. The incidence and hazard ratios of comorbidities related to aging and poor lifestyle were calculated using Cox proportional hazard regression modelsResults: The average age of the enrolled patients was approximately 66.5 years. The incidence ratio of hip fracture in HE group was 68/2496 (2.7 %), which was significantly higher than that in non-HE group as 98/9984 (0.98 %). Patients with hepatic encephalopathy were 2.15-times more likely to develop osteoporotic hip fractures than patients without hepatic encephalopathy in the whole group and the risk ratio was also significantly higher in female and older patients. The results were also similar in the comorbidity subgroups of hypertension, diabetes mellitus, hyperlipidemia, senile cataract, gastric ulcer and depression.Conclusions: Hepatic encephalopathy is significantly associated with an increased risk of osteoporotic hip fractures and the significance was not affected by the comorbidities in people aged more than 50 years old from the results of our study, and the risk cumulated steadily through time goes by. These patients would benefit from controlling their hepatic encephalopathy and reducing the subsequent osteoporotic hip fractures.