Risk of fractures and subsequent mortality in non‐alcoholic fatty liver disease: A nationwide population‐based cohort study

BACKGROUND: Studies suggest an association between osteoporosis and non‐alcoholic fatty liver disease (NAFLD), but whether patients with NAFLD are at increased risk of fractures is unknown. OBJECTIVES: The aim was to determine the rate and risk of fractures and the mortality rate after fracture in patients with NAFLD compared to the general population. METHODS: This was a nationwide population‐based cohort study using data from the Swedish National Patient Registry on 10,678 patients with NAFLD from 1987 to 2016. Patients were matched for sex, age, and municipality with 99,176 controls from the Swedish Total Population Registry. Cox regression was used to estimate fracture rates. The risk of fractures was assessed while accounting for competing risks (death and liver transplantation). RESULTS: A total of 12,312 fractures occurred during 761,176 person‐years of follow‐up. Patients with NAFLD (17.5 per 1000 person‐years) had a slightly higher fracture rate than controls (16.1 per 1000 person‐years; adjusted hazard ratio 1.11, 95% confidence interval [CI] 1.05–1.19), although the 5‐year risk of fractures was similar (8.0%, 95% CI 7.4–8.6 versus 7.3%, 95% CI 7.2–7.5). Additionally, 1‐year mortality after fracture was similar in NAFLD and controls. CONCLUSIONS: Patients with NAFLD have a slightly higher rate of fractures but long‐term risk of fractures comparable to the general population. This suggests that broad surveillance of risk factors for fractures in patients with NAFLD is not motivated.