Younger women with IBD prone to hip fractures

Female sex appears to be an independent risk factor for hip fracture among individuals with inflammatory bowel disease (IBD), findings from a nationally representative study suggest.

To determine the contributions of sex and age to the risk of hip fracture in individuals with and without IBD, the investigators conducted a retrospective cross-sectional analysis using the 2022 Nationwide Inpatient Sample. Adult patients hospitalized with hip fractures were identified via ICD-10 codes. Pathological fractures and high-impact trauma (eg, motor vehicle accidents) were excluded. Demographics, sex distribution, and mean age were compared between patients with and without IBD.

A total of 386,520 adult hip fracture hospitalizations were identified. Of these, 2,815 patients (0.73 percent) had IBD. [AIBD 2025, abstract 91]

Fifty-six percent of the IBD patients had Crohn’s disease (CD), while the remaining 44 percent had ulcerative colitis (UC). Looking at the mean age at the time of fracture, patients with CD were younger than those with UC (75.7 vs 78.6 years).

Seventy percent of the IBD patients were women. The corresponding percentage among those without IBD was 64.3 percent. A comparison between groups yielded a p-value of 0.0035.

After adjusting for comorbidities, female sex was independently associated with hip fracture in IBD (adjusted odds ratio, 1.32; p=0.004).

Women with IBD and hip fracture were younger than those without (mean age 76.9 vs 78.3 years). The age difference remained significant after adjusting for comorbidities (-1.63 years; p=0.006).

In the subgroup analyses, female predominance was more pronounced in the CD group, representing approximately 71.6 percent of hip fracture cases. In the UC group, the corresponding rate was 68.6 percent.

The role of chronic inflammation

Individuals with IBD are predisposed to low bone density and fragility fractures. The chronic inflammation associated with IBD leads to a reduction in bone mineral density, which, in turn, results in osteopenia and osteoporosis. [World J Gastrointest Pathophysiol 2015;6:210-218]

Malabsorption resulting from chronic intestinal inflammation leads to deficiencies in calcium, iron, vitamin D, and zinc. [Inflamm Bowel Dis 2006;12:185-191] In one study, corticosteroid-naïve patients with histological inflammation had a higher fracture risk than those with histological remission, highlighting the role of intestinal inflammation in the absence of other dominant risk factors. [Aliment Pharmacol Ther 2024;60:1549-1560]

The medications used to treat IBD (eg, corticosteroids, immunomodulators) also have a negative impact on bone metabolism. [Am J Gastroenterol 1997;92:1157-1163] A study has shown a nearly twofold risk of hip fracture in individuals taking steroids. [Ann Rheum Dis 1995;54:49-52]

IBD duration and ageing may also affect fracture risk. [Inflamm Bowel Dis 2022;28:126-132] Older women are classically known to be at higher risk for hip fractures. In a study, women aged 65 years with severe IBD have a 10-year probability of hip fracture of 7 percent. [Gastroenterology 2003;125:1591-1597] However, the extent and age-related profile of this risk within the IBD population remains inadequately characterized. [Endocr Pract 2023;29:478-483; J Korean Med Sci 2023;38:e275]

Takeaways

“[In this analysis,] women with IBD presented at a younger age with hip fracture, compared with those without IBD, suggesting accelerated skeletal vulnerability,” the investigators noted.

“These findings underscore the need for earlier and more proactive bone health surveillance, as well as fracture prevention strategies tailored to women with IBD,” they added.