title: Association between hypertension and fragility fracture: a longitudinal study.
abstract: Hypertension is an independent risk factor for osteoporosis and osteoporotic fracture in postmenopausal women.
  
  
  BACKGROUND
  Although hypertension has been suggested to be associated with increased fracture risk, it is not clear whether the association is independent of bone mineral density (BMD). The present study sought to examine the interrelationships between hypertension, BMD, and fracture risk.
  
  
  METHODS
  The study included 1,032 men and 1,701 women aged 50 years and older who were participants in the Dubbo Osteoporosis Epidemiology Study. BMD at the femoral neck and lumbar spine was measured by dual energy X-ray absorptiometry (GE-LUNAR Corp., Madison, WI, USA). The presence of hypertension was ascertained by direct interview and verification through clinical history. The incidence of fragility fractures was ascertained by X-ray report during the follow-up period (1989-2008). The Cox proportional hazards model was used to assess the association between hypertension and fracture risk.
  
  
  RESULTS
  Women with hypertension had lower BMD at the femoral neck (0.79 versus 0.82 g/cm(2), P = 0.02) than those without the disease. After adjusting for BMD and covariates, hypertension was an independent risk factor for fragility fracture [hazard ratio (HR), 1.49; 95% CI, 1.13-1.96]. In men, hypertension was associated with higher femoral neck BMD (0.94 versus 0.92 g/cm(2), P = 0.02), but the association between hypertension and fracture risk did not reach statistical significance.
  
  
  CONCLUSIONS
  Hypertension is associated with increased fracture risk in women, and the association is independent of BMD.
authors.affiliation: Division of Musculoskeletal Diseases, Garvan Institute of Medical Research, 384 Victoria Street, Sydney, New South Wales, 2010, Australia.
authors.forename: S
authors.initials: S
authors.lastname: Yang
authors.forename: N D
authors.initials: ND
authors.lastname: Nguyen
authors.forename: J R
authors.initials: JR
authors.lastname: Center
authors.forename: J A
authors.initials: JA
authors.lastname: Eisman
authors.forename: T V
authors.initials: TV
authors.lastname: Nguyen
mesh_terms: D015502:Absorptiometry, Photon; D000368:Aged; D015519:Bone Density / Q000502:physiology; D005260:Female; D005272:Femur Neck / Q000503:physiopathology; D006801:Humans; D006973:Hypertension / Q000150:complications* / Q000453:epidemiology / Q000503:physiopathology; D053208:Kaplan-Meier Estimate; D008137:Longitudinal Studies; D008159:Lumbar Vertebrae / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D009517:New South Wales / Q000453:epidemiology; D010024:Osteoporosis / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology; D015663:Osteoporosis, Postmenopausal / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology; D058866:Osteoporotic Fractures / Q000453:epidemiology / Q000209:etiology* / Q000503:physiopathology; D012307:Risk Factors
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