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Cardiovascular diseases and risk of hip fracture
JAMA, 10/22/09

Sennerby U et al. – 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.

• 31 936 Swedish twins born from 1914-1944 was followed up from age of 50 y
• National Patient Registry identified twins with CVDs and fractures from 1964 through 2005
• Time-dependent exposures using Cox proportional hazard regression models evaluated

• Crude absolute rate of hip fractures was 12.6 per 1000 person-years after diagnosis of HF, 12.6 per 1000 person-years after a stroke, 6.6 per 1000 person-years after diagnosis of peripheral atherosclerosis, and 5.2 per 1000 person-years after diagnosis of ischemic heart disease compared with 1.2 per 1000 person-years for those without CVD diagnosis
• Multivariable-adjusted hazard ratio (HR) of hip fracture after diagnosis of heart failure 4.40 ; after stroke, HR was 5.09 ; after diagnosis of peripheral atherosclerosis, HR was 3.20; and after ischemic heart disease event, HR was 2.32
• Identical twins without heart failure and stroke also had, after their co-twins had been exposed to respective diseases, an increased rate of hip fracture
• Sibling twins pseudoexposed for heart failure had multivariable-adjusted HR of 3.74 for hip fracture, whereas pseudoexposure for stroke had an HR of 2.29

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