Heart disease linked to hip fracture risk

(Ivanhoe Newswire) -- A new study finds the risk of hip fracture increased significantly following a diagnosis of cardiovascular disease (CVD).

CVD and osteoporosis, which are common in elderly individuals, have been regarded as independent age-related disorders. Research has suggested, however, that there may be common mechanisms that cause these diseases. Stroke is a well-documented risk factor for hip fracture, but it is uncertain whether other CVDs may increase the risk of future hip fracture.

Ulf Sennerby, M.D., of Uppsala University, Uppsala, Sweden, and colleagues used information from 31,936 twins in the Swedish Twin Registry to investigate the association between cardiovascular events and future hip fracture risk and to examine the extent to which the relation was attributable to genes or associated with other lifestyle factors. The researchers noted that a study that includes twins provides a framework for an ordinary group analysis while simultaneously examining whether the relation between cardiovascular events and hip fracture is explained by genetic and early environmental factors.

The twins, born from 1914-1944, were followed up from the age of 50 years. The researchers found that the rate of hip fractures was highest after a diagnosis of heart failure or stroke, compared to after a diagnosis of peripheral atherosclerosis or ischemic heart disease, and lowest for those without a CVD diagnosis.

Compared to individuals without CVD, patients with heart failure had about a four-fold increased rate of hip fracture and individuals with a stroke had five times the risk.

"Identical twins without heart failure and stroke also had, after their co-twins had been exposed to these respective diseases, an increased rate of hip fracture," the authors wrote. These sibling twins who were considered to be "pseudoexposed" (i.e., the twin without CVD was considered to be "pseudoexposed" to having CVD based of their co-twin having a CVD event) for heart failure had a 3.7-fold increased risk for hip fracture; pseudoexposure for stroke had a 2.3 times higher risk of hip fracture.

"An increased hip fracture risk for the pseudoexposure in the co-twin analyses, particularly in identical twins, is an indication that genes predispose to the development of CVD and fractures," the researchers wrote.

"Clinicians should be aware of the considerably increased rate of hip fracture in both sexes, especially after a recent hospitalization for CVD," the authors concluded. "Genetic predisposition is probably a major determinant of the excess fracture rate."

SOURCE: Journal of the American Medical Association, (JAMA) October 21, 2009

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