title: Peripheral arterial disease increases the risk of subsequent hip fracture in older men: the Health in Men Study.
abstract: The aim of the present study was to assess whether peripheral arterial disease is associated with an increased risk of hip fracture in a cohort of 12,094 older men. There was no association between claudication and hip fracture, but there was a significant association with an ankle brachial index (ABI) <0.9.
  
  
  BACKGROUND
  It is uncertain whether peripheral arterial disease (PAD) is associated with an increased risk of subsequent hip fracture. The aim of the present study was to assess this in a large cohort of men aged 65 years and over.
  
  
  METHODS
  Claudication was assessed by means of the Edinburgh Claudication Questionnaire in 12,094 men, and the ABI was measured in 4,321 of these men. Hospitalisations with hip fracture were identified by record linkage. The association between both claudication and an ABI <0.9 and subsequent hip fractures was assessed using survival curves and Cox regression models.
  
  
  RESULTS
  Amongst the 12,094 men, the baseline prevalence of claudication according to the ECQ was 5.3 %. Amongst the 4,321 men with ABI results, the prevalence of an ABI <0.9 was 11.7 %. Of the 506 men with an ABI <0.9, 129 (25.5 %) also had claudication. Over a median (range) follow-up of 10.8 (0.3-12.7) years, 343 (2.8 %) of the 12,094 men were admitted to hospital with a hip fracture. There was no association between claudication and subsequent hip fractures (hazard ratio (HR) = 0.95; 95 % confidence interval (CI), 0.60, 1.52). Over a median (range) follow-up of 11.1 (0.06-12.3) years 135 (3.1 %) of the 4,321 men with ABI data were admitted to hospital with hip fractures. There was a significant association between an ABI <0.9 and subsequent hip fracture (HR = 1.69; 95 % CI, 1.08, 2.63).
  
  
  CONCLUSIONS
  Older men with PAD defined as ABI < 0.9 are at increased risk of hip fracture, whereas the symptom of claudication is not an independent predictor of hip fracture.
authors.affiliation: Western Australian Centre for Health and Ageing, Centre for Medical Research, Western Australian Institute for Medical Research, University of Western Australia, Perth, WA, Australia.
authors.forename: Z
authors.initials: Z
authors.lastname: Hyde
authors.forename: K J
authors.initials: KJ
authors.lastname: Mylankal
authors.forename: G J
authors.initials: GJ
authors.lastname: Hankey
authors.forename: L
authors.initials: L
authors.lastname: Flicker
authors.forename: P E
authors.initials: PE
authors.lastname: Norman
mesh_terms: D000368:Aged; D055109:Ankle Brachial Index; D006620:Hip Fractures / Q000453:epidemiology / Q000209:etiology*; D006801:Humans; D007383:Intermittent Claudication / Q000150:complications / Q000453:epidemiology; D053208:Kaplan-Meier Estimate; D008297:Male; D058729:Peripheral Arterial Disease / Q000150:complications* / Q000453:epidemiology; D015995:Prevalence; D012307:Risk Factors; D014904:Western Australia / Q000453:epidemiology