Cardiovascular Diseases and Risk of Hip Fracture

JAMA. 2009 Oct 21;302(15):1666-73. doi: 10.1001/jama.2009.1463.


Context: Recent studies indicate common etiologies for cardiovascular disease (CVD) and osteoporotic fractures.

Objectives: To examine the relation between CVD and risk of hip fracture in twins and evaluate the relative importance of genetics and lifestyle factors in this association.

Design, setting, and participants: A cohort of all 31,936 Swedish twins born from 1914-1944 was followed up from the age of 50 years. The National Patient Registry identified twins with CVDs and fractures from 1964 through 2005. Time-dependent exposures using Cox proportional hazard regression models were evaluated.

Main outcome measure: Time to hip fracture after diagnosis of CVD.

Results: The crude absolute rate of hip fractures was 12.6 per 1000 person-years after a diagnosis of heart failure, 12.6 per 1000 person-years after a stroke, 6.6 per 1000 person-years after a diagnosis of peripheral atherosclerosis, and 5.2 per 1000 person-years after a diagnosis of ischemic heart disease compared with 1.2 per 1000 person-years for those without a CVD diagnosis. The multivariable-adjusted hazard ratio (HR) of hip fracture after a diagnosis of heart failure was 4.40 (95% confidence interval [CI], 3.43-5.63); after a stroke, the HR was 5.09 (95% CI, 4.18-6.20); after a diagnosis of peripheral atherosclerosis, the HR was 3.20 (95% CI, 2.28-4.50); and after an ischemic heart disease event, the HR was 2.32 (95% CI, 1.91-2.84). 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. These sibling twins pseudoexposed for heart failure had a multivariable-adjusted HR of 3.74 (95% CI, 1.97-7.10) for hip fracture, whereas pseudoexposure for stroke had an HR of 2.29 (95% CI, 1.20-4.35).

Conclusions: A diagnosis of CVD was significantly associated with risk of subsequent hip fracture. Increased risks in co-twins without an index diagnosis suggest genetic factors in the association between CVD and osteoporotic fractures.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Twin Study

MeSH terms

  • Aged
  • Aged, 80 and over
  • Cardiovascular Diseases / epidemiology*
  • Cardiovascular Diseases / genetics
  • Diseases in Twins / epidemiology*
  • Diseases in Twins / genetics
  • Female
  • Genetic Predisposition to Disease
  • Hip Fractures / epidemiology*
  • Hip Fractures / genetics
  • Humans
  • Kaplan-Meier Estimate
  • Life Style
  • Male
  • Middle Aged
  • Osteoporosis / epidemiology*
  • Osteoporosis / genetics
  • Proportional Hazards Models
  • Registries
  • Risk
  • Sweden
  • Twins