Jason A Sherer1, Qiuxi Huang2, Douglas P Kiel3, Emelia J Benjamin4, Ludovic Trinquart5. 1. Department of Medicine, Boston University School of Medicine, Mass. Electronic address: jsherer2016@gmail.com. 2. Department of Biostatistics, Boston University School of Public Health, Mass. 3. Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass; Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Department of Medicine Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Mass. 4. National Heart, Lung, and Blood Institute's and Boston University's Framingham Heart Study, Framingham, Mass; Preventive Medicine and Section of Cardiovascular Medicine, Department of Medicine, Boston University School of Medicine, Mass; Department of Epidemiology, Boston University School of Public Health, Mass. 5. Department of Biostatistics, Boston University School of Public Health, Mass; National Heart, Lung, and Blood Institute's and Boston University's Framingham Heart Study, Framingham, Mass.
Abstract
BACKGROUND: There is conflicting evidence regarding the association between atrial fibrillation and the risk of subsequent fractures. METHODS: We included participants aged 45 years or older from the Framingham Heart Study Offspring, Third-Generation, New Offspring Spouse, Omni 1, and Omni 2 cohorts. We prespecified analyzing index age 65 years as our primary analysis; we repeated analyses for index ages 45, 55, and 75 years. The primary outcome was any incident bone fracture, except finger, toe, foot, skull, and facial fractures. We assessed the association between time-varying atrial fibrillation and subsequent fractures by an illness-death model that accounted for the competing risk of death. We estimated hazard ratios (HR) adjusted for age, sex, body mass index, smoking, diabetes, alcohol intake, and prior fracture. RESULTS: We included 3403 participants (mean age of 68 years, 53.3% female) in the analysis at index age 65 years and above. In all, 525 (15%) participants suffered incident fractures during follow-up (median 12.5 years). The HR between atrial fibrillation and subsequent fracture was 1.37; 95% confidence interval (CI), 1.06-1.79. There was no evidence of effect modification by sex (HR 1.55; 95% CI, 1.06-2.26 in men; HR 1.22; 95% CI, 0.84-1.77 in women; interaction P value .27). Results were consistent at other index ages. CONCLUSION: Atrial fibrillation was associated with increased risk of incident fracture in the community-based Framingham Heart Study.
BACKGROUND: There is conflicting evidence regarding the association between atrial fibrillation and the risk of subsequent fractures. METHODS: We included participants aged 45 years or older from the Framingham Heart Study Offspring, Third-Generation, New Offspring Spouse, Omni 1, and Omni 2 cohorts. We prespecified analyzing index age 65 years as our primary analysis; we repeated analyses for index ages 45, 55, and 75 years. The primary outcome was any incident bone fracture, except finger, toe, foot, skull, and facial fractures. We assessed the association between time-varying atrial fibrillation and subsequent fractures by an illness-death model that accounted for the competing risk of death. We estimated hazard ratios (HR) adjusted for age, sex, body mass index, smoking, diabetes, alcohol intake, and prior fracture. RESULTS: We included 3403 participants (mean age of 68 years, 53.3% female) in the analysis at index age 65 years and above. In all, 525 (15%) participants suffered incident fractures during follow-up (median 12.5 years). The HR between atrial fibrillation and subsequent fracture was 1.37; 95% confidence interval (CI), 1.06-1.79. There was no evidence of effect modification by sex (HR 1.55; 95% CI, 1.06-2.26 in men; HR 1.22; 95% CI, 0.84-1.77 in women; interaction P value .27). Results were consistent at other index ages. CONCLUSION:Atrial fibrillation was associated with increased risk of incident fracture in the community-based Framingham Heart Study.
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