title: Osteoporotic fractures and heart failure in the community.
abstract: OBJECTIVE
  Recent findings suggest a role for heart failure in the etiology of osteoporotic fractures, yet the temporal sequence of occurrence of the 2 conditions needs clarification.
  
  
  METHODS
  Using the Rochester Epidemiology Project, the authors conducted a 2-phase study: a case-control study compared osteoporotic fracture history among Olmsted County, Minnesota, residents newly diagnosed with heart failure in 1979-2002 with age- and sex-matched community controls without heart failure (961 pairs; mean age 76 years; 54% women). Both groups were then followed to July 2009 to evaluate their subsequent fracture risk in a cohort study.
  
  
  RESULTS
  Prior fractures were more frequent in heart failure cases than controls (23.1% vs. 18.8%, P=.02). The adjusted odds ratio (OR) for heart failure associated with prior fracture was 1.39 (95% confidence interval [CI], 1.07-1.81), mainly driven by hip fractures (OR 1.82; 95% CI, 1.25-2.66) with little or no association with other fractures. Over a mean follow-up of 7.5 years, 444 individuals developed subsequent osteoporotic fractures. The adjusted fracture risk was marginally elevated in heart failure patients compared with controls (hazard ratio [HR] 1.32; 95% CI, 0.98-1.79), again largely attributable to hip fractures (HR 1.58; 95% CI, 1.03-2.41).
  
  
  CONCLUSIONS
  In this community, the association with fracture risk was about as strong before as after the diagnosis of heart failure and was nearly entirely attributable to hip fractures. Additional work is needed to identify common underlying mechanisms for heart failure and hip fracture, which may define prevention opportunities.
authors.affiliation: Department of Health Sciences Research, College of Medicine, Mayo Clinic, Rochester, MN 55905, USA.
authors.forename: Yariv
authors.initials: Y
authors.lastname: Gerber
authors.forename: L Joseph
authors.initials: LJ
authors.lastname: Melton
authors.forename: Susan A
authors.initials: SA
authors.lastname: Weston
authors.forename: Véronique L
authors.initials: VL
authors.lastname: Roger
mesh_terms: D000058:Accidental Falls; D000368:Aged; D000369:Aged, 80 and over; D015519:Bone Density; D016022:Case-Control Studies; D005260:Female; D006333:Heart Failure / Q000150:complications* / Q000209:etiology; D006620:Hip Fractures / Q000150:complications; D006801:Humans; D008297:Male; D008875:Middle Aged; D008910:Minnesota / Q000453:epidemiology; D016017:Odds Ratio; D058866:Osteoporotic Fractures / Q000150:complications* / Q000209:etiology; D018570:Risk Assessment; D012307:Risk Factors; D016103:Spinal Fractures / Q000150:complications