Chronic Liver Disease and Hip Fracture Risk: A Comprehensive Meta-Analysis of Over a Million Patients

Background: Chronic liver disease (CLD) can impair bone health and has been linked to osteoporosis and fractures, but its association with hip fracture risk remains unclear. This systematic review and meta-analysis summarizes the current evidence on the association between CLD and the risk of hip fracture in adults. Methods: We conducted this systematic review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 statement. Four electronic databases (PubMed, Web of Science, Scopus, and Cochrane Library) were searched for cohort studies reporting the risk of hip fracture in adult patients with CLD. Two groups of authors independently performed screening, quality assessment, data extraction, and analysis. Hazard ratios (HRs) with 95% confidence intervals (CIs) were pooled using the generic inverse-variance method in Review Manager (RevMan) version 5.1. Results: Three retrospective cohort studies comprising 1,128,658 adults were included. CLD was not associated with a statistically significant increase in hip fracture risk compared with the non-CLD group (pooled HR 1.34; 95% CI 0.86–2.09; P = 0.20), with considerable heterogeneity across studies (I² = 94%). In leave-one-out sensitivity analyses, after excluding the study identified as the main source of heterogeneity, heterogeneity resolved (I² = 0%) and the pooled HR remained non-significant (1.04; 95% CI 0.93–1.16; P = 0.53). Conclusions: The available evidence does not demonstrate a statistically significant association between CLD and hip fracture risk; however, it is limited to three heterogeneous studies and the pooled estimate was imprecise, so no firm conclusion can be drawn. Further research on specific types and severities of CLD is needed to clarify this relationship and to develop guidelines for hip fracture prevention in patients with CLD.