March 18, 2014

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

Journal of Hepatology

Article in Press

Ann-Brit Eg Hansen, Lars Haukali Omland, Henrik Krarup, Niels Obel, on behalf of the DANVIR cohort study

Received 22 December 2013; received in revised form 6 March 2014; accepted 7 March 2014. published online 18 March 2014.
Accepted Manuscript


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.


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.


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).


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.

Abbreviations: HCV, hepatitis C virus, CI, confidence interval, aIRR, adjusted incidence rate ratio, BMD, bone mineral density, CRS, Civil Registration System, DNPR, Danish National Hospital Registry, I CD-8, International Classification of Diseases, revision 8, ICD-10, International Classification of Diseases, revision 8, IDU, intravenous drug use, CCI, Charlsons Comorbidity Index, IRR, incidence rate ratio, PY, person years of observation

Keywords: Fracture risk, Chronic HCV, Cleared HCV, Comorbidity

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