T Jiang1, K Veres2, D Körmendiné Farkas2, T L Lash2,3, H T Sørensen2, J L Gradus4,5,6,7. 1. Department of Epidemiology, Boston University, 715 Albany Street, Boston, MA, 02118, USA. 2. Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark. 3. Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA. 4. Department of Epidemiology, Boston University, 715 Albany Street, Boston, MA, 02118, USA. jgradus@bu.edu. 5. Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark. jgradus@bu.edu. 6. Department of Psychiatry, Boston University, Boston, MA, USA. jgradus@bu.edu. 7. National Center for PTSD, VA Boston Healthcare System, Boston, MA, USA. jgradus@bu.edu.
Abstract
Psychological stress may be associated with increased risk of fractures. It is unknown whether post-traumatic stress disorder (PTSD), a marker of chronic severe psychological stress occurring in response to a traumatic event, influences fracture risk. In this nationwide cohort study, persons with PTSD had an increased risk of fractures compared to the general population. INTRODUCTION: We conducted a population-based national cohort study in Denmark to examine the association between PTSD and incident fractures. METHODS: We examined the incidence rate of overall and specific fractures among patients with clinician-diagnosed PTSD (n = 4114), compared with the incidence rate in the general population from 1995 to 2013, using Danish medical registry data. We further examined differences in associations by gender, age, psychiatric and somatic comorbidity, and follow-up time. We calculated absolute risks, standardized incidence ratios (SIRs), and 95% confidence intervals (95% CIs). RESULTS: Risk of any fracture among persons with PTSD was 24% (95% CI 20%, 28%) over the study period. The SIR for any fracture was 1.7 (95% CI 1.6, 1.9). We found little evidence of effect measure modification of the association between PTSD and fractures in our stratified analyses. CONCLUSIONS: Our findings suggest that PTSD is associated with increased fracture risk.
Psychological stress may be associated with increased risk of fractures. It is unknown whether post-traumatic stress disorder (PTSD), a marker of chronic severe psychological stress occurring in response to a traumatic event, influences fracture risk. In this nationwide cohort study, persons with PTSD had an increased risk of fractures compared to the general population. INTRODUCTION: We conducted a population-based national cohort study in Denmark to examine the association between PTSD and incident fractures. METHODS: We examined the incidence rate of overall and specific fractures among patients with clinician-diagnosed PTSD (n = 4114), compared with the incidence rate in the general population from 1995 to 2013, using Danish medical registry data. We further examined differences in associations by gender, age, psychiatric and somatic comorbidity, and follow-up time. We calculated absolute risks, standardized incidence ratios (SIRs), and 95% confidence intervals (95% CIs). RESULTS: Risk of any fracture among persons with PTSD was 24% (95% CI 20%, 28%) over the study period. The SIR for any fracture was 1.7 (95% CI 1.6, 1.9). We found little evidence of effect measure modification of the association between PTSD and fractures in our stratified analyses. CONCLUSIONS: Our findings suggest that PTSD is associated with increased fracture risk.
Authors: George Ioannidis; Shelley Pallan; Alexandra Papaioannou; Manisha Mulgund; Lorena Rios; Jinhui Ma; Lehana Thabane; Kenneth S Davison; Robert G Josse; Christopher S Kovacs; Nancy Kreiger; Wojciech P Olszynski; Jerilynn C Prior; Tanveer Towheed; Jonathan D Adachi Journal: Arch Osteoporos Date: 2014-02-28 Impact factor: 2.617