Dana D Byrne1, Craig W Newcomb2, Dena M Carbonari3, Melissa S Nezamzadeh3, Kimberly B F Leidl2, Maximilian Herlim2, Yu-Xiao Yang1, Sean Hennessy3, Jay R Kostman4, Mary B Leonard5, A Russell Localio2, Vincent Lo Re6. 1. Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Department of Biostatistics and Epidemiology, Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Center for Pharmacoepidemiology Research and Training, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA. 2. Department of Biostatistics and Epidemiology, Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA. 3. Department of Biostatistics and Epidemiology, Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Center for Pharmacoepidemiology Research and Training, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA. 4. Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA. 5. Department of Biostatistics and Epidemiology, Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Department of Pediatrics, The Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA. 6. Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Department of Biostatistics and Epidemiology, Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Center for Pharmacoepidemiology Research and Training, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA. Electronic address: vincentl@mail.med.upenn.edu.
Abstract
BACKGROUND & AIMS: Chronic hepatitis B (CHB) infection is associated with reduced bone mineral density, but its association with fractures is unknown. Our objectives were to determine whether untreated or treated CHB-infected persons are at increased risk for hip fracture compared to uninfected persons. METHODS: We conducted a cohort study among 18,796 untreated CHB-infected, 7777 treated CHB-infected, and 979,751 randomly sampled uninfected persons within the U.S. Medicaid populations of California, Florida, New York, Ohio, and Pennsylvania (1999-2007). CHB infection was defined by two CHB diagnoses recorded >6 months apart and was classified as treated if a diagnosis was recorded and antiviral therapy was dispensed. After propensity score matching of CHB-infected and uninfected persons, Cox regression was used to estimate hazard ratios (HRs) with 95% confidence intervals (CIs) of incident hip fracture in: (1) untreated CHB-infected vs. uninfected, and (2) treated CHB-infected vs. uninfected patients. RESULTS: Untreated CHB-infected patients of black race had a higher rate of hip fracture than uninfected black persons (HR, 2.55 [95% CI, 1.42-4.58]). Compared to uninfected persons, relative hazards of hip fracture were increased for untreated white (HR, 1.26 [95% CI, 0.98-1.62]) and Hispanic (HR, 1.36 [95% CI, 0.77-2.40]) CHB-infected patients, and treated black (HR, 3.09 [95% CI, 0.59-16.22]) and white (HR, 1.90 [95% CI, 0.81-4.47]) CHB-infected patients, but these associations were not statistically significant. CONCLUSIONS: Among U.S. Medicaid enrollees, untreated CHB-infected patients of black race had a higher risk of hip fracture than uninfected black persons.
BACKGROUND & AIMS:Chronic hepatitis B (CHB) infection is associated with reduced bone mineral density, but its association with fractures is unknown. Our objectives were to determine whether untreated or treated CHB-infectedpersons are at increased risk for hip fracture compared to uninfected persons. METHODS: We conducted a cohort study among 18,796 untreated CHB-infected, 7777 treated CHB-infected, and 979,751 randomly sampled uninfected persons within the U.S. Medicaid populations of California, Florida, New York, Ohio, and Pennsylvania (1999-2007). CHB infection was defined by two CHB diagnoses recorded >6 months apart and was classified as treated if a diagnosis was recorded and antiviral therapy was dispensed. After propensity score matching of CHB-infected and uninfected persons, Cox regression was used to estimate hazard ratios (HRs) with 95% confidence intervals (CIs) of incident hip fracture in: (1) untreated CHB-infected vs. uninfected, and (2) treated CHB-infected vs. uninfected patients. RESULTS: Untreated CHB-infectedpatients of black race had a higher rate of hip fracture than uninfected black persons (HR, 2.55 [95% CI, 1.42-4.58]). Compared to uninfected persons, relative hazards of hip fracture were increased for untreated white (HR, 1.26 [95% CI, 0.98-1.62]) and Hispanic (HR, 1.36 [95% CI, 0.77-2.40]) CHB-infectedpatients, and treated black (HR, 3.09 [95% CI, 0.59-16.22]) and white (HR, 1.90 [95% CI, 0.81-4.47]) CHB-infectedpatients, but these associations were not statistically significant. CONCLUSIONS: Among U.S. Medicaid enrollees, untreated CHB-infectedpatients of black race had a higher risk of hip fracture than uninfected black persons.
Authors: Nicole C Wright; Kenneth G Saag; Jeffrey R Curtis; Wilson K Smith; Meredith L Kilgore; Michael A Morrisey; Huifeng Yun; Jie Zhang; Elizabeth S Delzell Journal: J Bone Miner Res Date: 2012-11 Impact factor: 6.741
Authors: G M McQuillan; P J Coleman; D Kruszon-Moran; L A Moyer; S B Lambert; H S Margolis Journal: Am J Public Health Date: 1999-01 Impact factor: 9.308
Authors: Vincent Lo Re; Giovanni Guaraldi; Mary B Leonard; Anthony R Localio; Jennifer Lin; Gabriella Orlando; Lucia Zirilli; Vincenzo Rochira; Jay R Kostman; Pablo Tebas Journal: AIDS Date: 2009-10-23 Impact factor: 4.177
Authors: D D Byrne; C W Newcomb; D M Carbonari; M S Nezamzadeh; K B F Leidl; M Herlim; Y X Yang; S Hennessy; J R Kostman; M B Leonard; A R Localio; V Lo Re Journal: J Viral Hepat Date: 2015-03-06 Impact factor: 3.728
Authors: Jessie Torgersen; Tamar H Taddei; Lesley S Park; Dena M Carbonari; Michael J Kallan; Kisha Mitchell Richards; Xuchen Zhang; Darshana Jhala; Norbert Bräu; Robert Homer; Kathryn D'Addeo; Rajni Mehta; Melissa Skanderson; Farah Kidwai-Khan; Amy C Justice; Vincent Lo Re Journal: Cancer Epidemiol Biomarkers Prev Date: 2019-10-01 Impact factor: 4.254