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. 2011 Jul 19;124(3):297-303.
doi: 10.1161/CIRCULATIONAHA.110.007195. Epub 2011 Jun 27.

Association Between Myocardial Infarction and Fractures: An Emerging Phenomenon

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Free PMC article

Association Between Myocardial Infarction and Fractures: An Emerging Phenomenon

Yariv Gerber et al. Circulation. .
Free PMC article

Abstract

Background: Data on the association between myocardial infarction (MI) and fractures are scarce. Recent changes in the epidemiology of MI justify exploring this relationship. We evaluated whether MI constitutes a risk factor for osteoporotic fracture and examined secular trends in this association.

Methods and results: Consecutive Olmsted County, Minnesota, residents with incident MI diagnosed in 1979 to 2006 and community control subjects individually matched (1:1) to cases on age, sex, and year of onset (n=6642) were followed up through 2009. Outcome measures were time to osteoporotic fracture, overall and by anatomic site, and death. Fracture incidence rates were stable in controls but increased markedly over time among MI cases. Accordingly, although an overall excess of fracture risk after MI was observed (adjusted hazard ratio, 1.32; 95% confidence interval, 1.12 to 1.56), substantial temporal variations were noted (1979 to 1989: hazard ratio, 0.81; 95% confidence interval, 0.58 to 1.12; 1990 to 1999: hazard ratio, 1.47; 95% confidence interval, 1.10 to 1.96; 2000 to 2006: hazard ratio, 1.73; 95% confidence interval, 1.32 to 2.27; P for trend <0.001). Trends were similar regardless of age, sex or fracture site. Conversely, the overall hazard ratio for death in MI cases versus controls did not change materially despite a continuous decline in 30-day case fatality rate (12.5% in 1979 to 1989; 6.7% in 2000 to 2006). Observed changes in the baseline prevalence of cardiovascular risk factors, MI characteristics, and comorbidities did not fully account for the trends in fracture risk.

Conclusions: Over the past decades, the association between MI and osteoporotic fractures increased steadily. The trend is consistent with the displacement of post-MI outcomes toward noncardiovascular events, highlighting the need for comprehensive prevention strategies to accommodate the changing epidemiology of MI.

Figures

Figure 1
Figure 1
Osteoporotic fracture-free survival curves by time period adjusted for age, sex, and prior fracture among Olmsted County, Minnesota residents with incident myocardial infarction in 1979-2006 versus community controls.
Figure 2
Figure 2
Biennial age-, sex-, and prior osteoporotic fracture-adjusted hazard ratios (HR) and 95% confidence intervals (CI) for subsequent osteoporotic fracture among Olmsted County, Minnesota residents with incident myocardial infarction in 1979-2006 versus community controls. HR (95% CI) are presented on a logarithmic scale.

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