title: Hypertension is a risk factor for fractures.
abstract: To study the effects of hypertension and other cardiovascular risk factors on risk of fractures, we carried out a case-control study including 124,655 fracture cases and 373,962 age- and gender-matched controls. The main exposure was hypertension, stroke, acute myocardial infarction, ischemic heart disease, atrial fibrillation, peripheral arterial disease, and deep venous thromboembolism, and the main confounders were use of diuretics, antihypertensive drugs, organic nitrates, vitamin K antagonists, and cholesterol lowering drugs along with other confounders. Hypertension and stroke were the only significant risk factors in both the short-term (OR = 1.27, 95% CI = 1.20-1.34 and 1.24, and 95% CI = 1.16-1.31 for < or = 3 years since diagnosis of hypertension and stroke, respectively) and the long-term (OR = 1.11, 95% CI = 1.00-1.23 and 1.09, and 95% CI = 1.02-1.18 for > 6 years since diagnosis of hypertension and stroke, respectively) perspective. Acute myocardial infarction, atrial fibrillation, and deep venous thromboembolism were all associated with a transient increase in the risk of fractures within the first 3 years following diagnosis. Peripheral arterial disease and ischemic heart disease were not associated with an increased risk of fractures. In conclusion, hypertension and stroke seem to be the major cardiovascular risk factors for fractures, whereas acute myocardial infarction, atrial fibrillation, and deep venous thromboembolism seem to be only minor risk factors. The fracture risk in hypertension may explain why antihypertensive drugs as a class effect are associated with a decreased risk of fractures. These drugs may counter some of the deleterious effects of high blood pressure.
authors.affiliation: Department of Endocrinology and Metabolism C, The Osteoporosis Clinic, Aarhus Amtssygehus, Aarhus University Hospital, Tage Hansens Gade 2, 8000 Aarhus C, Denmark. p-vest@post4.tele.dk
authors.forename: Peter
authors.initials: P
authors.lastname: Vestergaard
authors.forename: Lars
authors.initials: L
authors.lastname: Rejnmark
authors.forename: Leif
authors.initials: L
authors.lastname: Mosekilde
mesh_terms: D000328:Adult; D000368:Aged; D000959:Antihypertensive Agents / Q000009:adverse effects / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000150:complications; D016022:Case-Control Studies; D005260:Female; D050723:Fractures, Bone / Q000453:epidemiology / Q000209:etiology*; D006801:Humans; D006973:Hypertension / Q000150:complications* / Q000188:drug therapy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications; D012307:Risk Factors; D020521:Stroke / Q000150:complications / Q000188:drug therapy; D020246:Venous Thrombosis / Q000150:complications
chemical_list: D000959:Antihypertensive Agents