Fracture risk after surgery for peptic ulcer disease: A population-based cohort study

In the 30-year period from 1956 to 1985, 471 Rochester, RIN residents had a n initial operation for peptic ulcer disease, 438 of whom were followed for at least 30 days (median 14.8 gears per subject). In this population-based cohort, risk was elevated for all of the fracture sites traditionally asso ciated with osteoporosis, including the proximal femur (standardized incide nce ratio [SIR] 2.5, 95% CT 1.9-3.3), vertebra (SIR 4.7, 95% CI 3.8-5.7), a nd distal forearm (SIR 2.2, 95% CI 1.5-3.1), Fracture risk rose with age an d was greater among a-omen than men, but there was no influence on overall fracture risk of ulcer type or nature of the operation. In multivariate ana lyses, the independent predictors of vertebral fractures were age (hazard r atio [HR] per 10-year increase 1.8, 95% CI 1.6-2.0), use of corticosteroids (HR 2.3 95% CI 1.01-5.2), thyroid replacement (HR 2.5, 95% CI 1.4-4.6), ch ronic anticoagulation (HR 2.3, 95% CI 1.1-4.6), and the presence of one or more conditions associated with secondary osteoporosis (HR 1.6, 95% CI 1.2- 2.1), Gastrectomy with Billroth II reconstruction appeared to be relatively protective (HR 0.5, 95% CI 0.3-0.9), but such patients still had an increa sed risk of vertebral fractures compared with community residents generally (SIR 3.6, 95% CI 2.4-5.4). The independent predictors of hip fracture risk in this cohort were age (HR 2.7, 95% CI 2.1-3.5) and use of corticosteroid s (HR 5.8, 95% CI 2.2-15.3) or anticonvulsants (HR 4.6, 95% CI 1.8-12.0), w hile higher body mass index was protective (HR 0.9, 95% CT 0.8-0.96), The i ndependent predictors of distal forearm fractures were female gender (HR 4. 7, 95% CI 2.2-10.1) and chronic anticoagulant use (HR 2.8, 95% CI 1.1-7.3), Thus, while the risk of osteoporotic fractures was significantly increased among patients operated for peptic ulcers, this appeared to be due more to specific characteristics of the cohort than to adverse effects of particul ar surgical procedures, (C) 1999 by Elsevier Science Inc. All rights reserv ed.