To the editor
We read with great interest the study by Lin et al [Citation1] investigating the potential effect of gallstone disease (GSD) on the long-term risk of subsequent hip fracture. Lin et al [Citation1] provided valuable and innovative clinical information and noted that 550 (2.66%) hip fractures occurred in the study group (N = 20,639) and after adjustment, patients with GSD were at higher risk of subsequent hip fracture than the controls (aHR, 3.04; 95% CI, 2.79 − 3.32). However, we have a few concerns about the methodology and residual confounding factors.
First, we would like to clarify the age of the patient enrolled in the case. The narrative states that cases over 20 years of age were excluded, but in Table 1–3, it was shown that the age of acceptance was over 18 years.
Second, as for the factors associated with hip fracture, the authors had included the use of steroids and PPIs in the adjustment process. However, according to previous studies, tramadol, opioids and sedative-hypnotics drugs are very important medication in association with fall down and hip fracture [Citation2,Citation3]. If these medications can be considered in their analysis, it would increase the accuracy of their findings.
Third, the authors have included pertinent comorbidities that may affect the occurrence of hip fracture. However, dementia and Parkinson’s disease are also well-known risks for hip fracture, and were not included in the study [Citation4,Citation5]. Besides, the authors had made an argument that chronic inflammatory response is correlated with osteoporosis, and hip fracture, but they did not include other relevant comorbidities in association with chronic inflammation and osteopenia, such as rheumatoid arthritis, psoriasis, ankylosing spondylitis, systemic lupus erythematosus, multiple sclerosis, inflammatory bowel diseases, pemphigus vulgaris [Citation6] in their analysis. If these confounding factors can be involved in the study, the conclusion of the positive correlation between GSD and hip fracture will be clearer.
We look forward to their response to clarify these issues in the study.
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Disclosure of any financial/other conflict of interest
The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.
Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.
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References
- Lin CJ, Hsu CJ, Chen CH, et al. The association between gallstone disease (GSD) and Hip fracture: a nationwide population-based study. Postgrad Med. 2021 Apr;133(3):357–361.
- Wei J, Lane NE, Bolster MB, et al. Association of Tramadol use with risk of hip fracture. J Bone Miner Res. 2020 Apr;35(4):631–640.
- Emeny RT, Chang CH, Skinner J, et al. Association of receiving multiple, concurrent fracture-associated drugs with hip fracture risk. JAMA Network Open. 2019 Nov 1;2(11):e1915348.
- Jeon JH, Park JH, Oh C, et al. Dementia is associated with an increased risk of hip fractures: a nationwide analysis in Korea. J Clin Neurol. 2019 Apr;15(2):243–249.
- Nam JS, Kim YW, Shin J, et al. Hip fracture in patients with Parkinson’s disease and related mortality: a population-based study in Korea. Gerontology. 2021;67(5):544–553.
- Straub RH, Cutolo M, Pacifici R. Evolutionary medicine and bone loss in chronic inflammatory diseases–A theory of inflammation-related osteopenia. Semin Arthritis Rheum. 2015 Oct;45(2):220–228.