Assessment of Sex Differences in Fracture Risk Among Patients With Anorexia Nervosa: A Population-Based Cohort Study Using The Health Improvement Network.

TitleAssessment of Sex Differences in Fracture Risk Among Patients With Anorexia Nervosa: A Population-Based Cohort Study Using The Health Improvement Network.
Publication TypeJournal Article
Year of Publication2017
AuthorsNagata JM, Golden NH, Leonard MB, Copelovitch L, Denburg MR
JournalJ Bone Miner Res
Volume32
Issue5
Pagination1082-1089
Date Published2017 May
ISSN1523-4681
KeywordsAdult, Age Factors, Anorexia Nervosa, Cohort Studies, Databases, Factual, Female, Fractures, Bone, Humans, Male, Retrospective Studies, Risk Factors, Sex Characteristics, Sex Factors
Abstract

Though previous studies have demonstrated an increased fracture risk in females with anorexia nervosa (AN), fracture risk in males is not well characterized. The objective of this study was to examine sex differences in fracture risk and site-specific fracture incidence in AN. We performed a population-based retrospective cohort study using The Health Improvement Network (THIN; a large database of anonymized electronic medical records collected at primary care clinics throughout the United Kingdom). The median calendar year for the start of the observation period was 2004-2005. We identified 9239 females and 556 males <60 years of age with AN, and 97,889 randomly selected sex-, age-, and practice-matched participants without eating disorders (92,329 females and 5560 males). Multivariable Cox regression was used to estimate the hazard ratio (HR) for incident fracture. Median age at start of observation was 29.8 years in females and 30.2 years in males. The HR for fracture associated with AN differed by sex and age (interaction p = 0.002). Females with AN had an increased fracture risk at all ages (HR, 1.59; 95% confidence interval [CI], 1.45 to 1.75). AN was associated with a higher risk of fracture among males >40 years of age (HR, 2.54; 95% CI, 1.32 to 4.90; p = 0.005) but not among males ≤40 years. Females with AN had a higher risk of fracture at nearly all anatomic sites. The greatest excess fracture risk was noted at the hip/femur (HR, 5.59; 95% CI, 3.44 to 9.09) and pelvis (HR, 4.54; 95% CI, 2.42 to 8.50) in females and at the vertebrae (HR, 7.25; 95% CI, 1.21 to 43.45) for males with AN. AN was associated with higher incident fracture risk in females across all age groups and in males >40 years old. Sites of highest fracture risk include the hip/femur and pelvis in females and vertebrae in males with AN. © 2016 American Society for Bone and Mineral Research.

DOI10.1002/jbmr.3068
Alternate JournalJ. Bone Miner. Res.
PubMed ID28019700
PubMed Central IDPMC5413380
Grant ListK23 DK093556 / DK / NIDDK NIH HHS / United States
R01 HD082166 / HD / NICHD NIH HHS / United States
UL1 RR024134 / RR / NCRR NIH HHS / United States