WebMD Medical News
Elizabeth Klodas, MD, FACC
Oct. 20, 2009 -- A diagnosis of cardiovascular disease significantly
increases the risk of future hip fracture, and there may be a genetic
predisposition to both conditions, a new study shows.
Ulf Sennerby, MD, of Uppsala University, Sweden, and colleagues studied
records of 31,936 twins in the Swedish Twin Registry. The researchers looked at
whether elderly people may be genetically predisposed to develop both
cardiovascular disease and hip fractures.
Previous data have suggested that common biologic factors underlie both
diseases, and the investigators wanted to determine the extent of any
relationship between the diseases and genes or lifestyle factors.
Their results are reported in the Oct. 21 issue of The Journal of the
American Medical Association.
The researchers note 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 were born from 1914 to 1944 and data on each was studied from the
age of 50. Twins with cardiovascular disease and fractures were
identified by the National Patient Registry from 1964 through 2005.
Among the study's findings:
• The absolute rate of hip
fractures was highest after a diagnosis of heart failure or stroke. The rate
was not as high following a diagnosis of peripheral atherosclerosis or ischemic
heart disease, and was lowest for people without cardiovascular disease.
• Compared to people without
cardiovascular disease, patients with heart failure had about a fourfold
increase in hip fracture rates; individuals with a stroke had a fivefold
increase in hip fracture rates.
"Identical twins without heart failure and stroke also had an increased rate
of hip fracture after their co-twins were exposed to these respective
diseases," the researchers write. The association was also present, but not as
strong for non-identical twins.
This suggests that genes predispose people to the development of both
cardiovascular disease and hip fractures, the researchers report.
In the total population studied:
• The average hip fracture
rate was 12.6 per 1,000 person-years after a diagnosis of heart failure.
• The hip fracture rate also
was 12.6 per 1,000 person years after a stroke, 6.6 after a diagnosis of
peripheral atherosclerosis, and 5.1 after a diagnosis of ischemic heart
Those numbers compared with just 1.2 per 1,000 person years for those
without cardiovascular disease.
"Clinicians should be aware of the considerably increased rate of hip
fracture in both sexes, especially after a recent hospitalization for
[cardiovascular disease]," the researchers argue. "Genetic predisposition is
probably a major determinant of the excess fracture rate."
SOURCES:News release, Uppsala University, Sweden.Sennerby, U. The Journal of the American Medical Association, Oct.
21, 2009; vol 302: pp 1666-1673.
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