Fracture risk in hepatitis C virus infected persons: results from the DANVIR cohort study

BACKGROUND AND AIMS: The association between Hepatitis C virus (HCV)-infection and fracture risk is not well characterized. We compared fracture risk between HCV-seropositive (HCV-exposed) patients and the general population and between patients with cleared and chronic HCV-infection.

METHODS: Outcome measures were time to first fracture at any site, time to first low-energy and first non low-energy (other) fracture in 12,013 HCV-exposed patients from the DANVIR cohort compared with a general population control cohort (n = 60,065) matched by sex and age. Within DANVIR, 4500 patients with chronic HCV-infection and 2656 patients with cleared HCV-infection were studied.

RESULTS: Compared with population controls, HCV-exposed patients had increased overall risk of fracture [adjusted incidence rate ratio (aIRR) 2.15, 95% Confidence Interval (CI) 2.03 - 2.28], increased risk of low-energy fracture (aIRR 2.13, 95% CI 1.93 - 2.35) and of other fracture (aIRR 2.18, 95% CI 2.02 - 2.34). Compared with cleared HCV-infection, chronic HCV-infection was not associated with increased risk of fracture at any site (aIRR 1.08, 95% CI 0.97 - 1.20), or other fracture (aIRR 1.04, 95% CI 0.91 - 1.19). The aIRR for low-energy fracture was 1.20 (95% CI 0.99 - 1.44).

CONCLUSIONS: HCV-exposed patients had increased risk of all fracture types. In contrast, overall risk of fracture did not differ between patients with chronic versus cleared HCV-infection, although chronic HCV-infection might be associated with a small excess risk of low-energy fractures. Our study suggests that fracture risk in HCV-infected patients is multi-factorial and mainly determined by lifestyle-related factors associated with HCV-exposure.