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It is unclear if this risk varies by recent histological activity.<\/jats:p><\/jats:sec><jats:sec><jats:title>Aims<\/jats:title><jats:p>To determine the fracture risk in IBD during periods with and without histological inflammation.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We studied a nationwide cohort of 54,591 individuals diagnosed with IBD in 1990\u20132016 with longitudinal data on ileo\u2010colorectal biopsies. Fractures were identified by inpatient and hospital\u2010based outpatient diagnoses. We derived Cox regression estimated hazard ratios (HRs) for fracture during 12\u2009months following a histological inflammation (vs. histological remission) record after adjusting for socio\u2010demographics, comorbidities, IBD duration, IBD\u2010related surgery and hospitalization. We adjusted sensitivity analyses for medical IBD treatment including corticosteroids.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Mean age of patients was 44.0 (SD\u2009=\u200918.3) and 45.5 (SD\u2009=\u200917.1) years at biopsy with histological inflammation and remission, respectively. For histological inflammation, there were 1.37 (95% CI 1.29\u20131.46) fractures per 100\u2009years' follow\u2010up versus 1.31 (95% CI 1.19\u20131.44) for remission (adjusted [a]HR 1.12; 95% CI 1.00\u20131.26; <jats:italic>p<\/jats:italic>\u2009=\u20090.04). HRs were similar with histological inflammation of Crohn's disease (1.11; 95% CI 0.91\u20131.36) and ulcerative colitis (1.18; 95% CI 1.02\u20131.36). Estimates were consistent across age groups. An overall small excess risk of any fracture remained after accounting for corticosteroids. A more prominently raised fracture risk was observed in corticosteroid\u2010na\u00efve IBD patients with histological inflammation versus histological remission (aHR 1.41; 95% CI 1.07\u20131.85). The aHR of hip fracture following histological inflammation was 1.29 (95% CI 0.87\u20131.92).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Histological inflammation in IBD predicted a small increase in short\u2010term fracture risk. Measures to reduce disease activity may reduce fracture risk in IBD.<\/jats:p><\/jats:sec>","DOI":"10.1111\/apt.18275","type":"journal-article","created":{"date-parts":[[2024,9,23]],"date-time":"2024-09-23T08:13:07Z","timestamp":1727079187000},"page":"1549-1560","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["A nationwide cohort study of inflammatory bowel disease, histological activity and fracture risk"],"prefix":"10.1111","volume":"60","author":[{"given":"Karl","family":"M\u00e5rild","sequence":"first","affiliation":[{"name":"Department of Pediatrics Institute of Clinical Sciences, Sahlgrenska Academy  Gothenburg Sweden"},{"name":"Department of Pediatrics Queen Silvia Children's Hospital  Gothenburg Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonas","family":"S\u00f6derling","sequence":"additional","affiliation":[{"name":"Department of Medical Epidemiology and Biostatistics 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