The Impact of Disease and Drugs on Hip Fracture Risk.
We report the risks of a comprehensive range of disease and drug categories on hip fracture occurrence using a strict population-based cohort design. Participants included the source population of a Swedish county, aged ≥50 years (n = 117,494) including all incident hip fractures during 1 year (n = 477). The outcome was hospitalization for hip fracture (ICD-10 codes S72.0-S72.2) during 1 year (2009-2010). Exposures included: prevalence of (1) inpatient diseases [International Classification of Diseases (ICD) codes A00-T98 in the National Patient Register 1987-2010] and (2) prescribed drugs dispensed in 2010 or the year prior to fracture. We present age- and sex-standardized risk ratios (RRs), risk differences (RDs) and population attributable risks (PARs) of disease and drug categories in relation to hip fracture risk. All disease categories were associated with increased risk of hip fracture. Largest risk ratios and differences were for mental and behavioral disorders, diseases of the blood and previous fracture (RRs between 2.44 and 3.00; RDs (per 1000 person-years) between 5.0 and 6.9). For specific drugs, strongest associations were seen for antiparkinson (RR 2.32 [95 % CI 1.48-1.65]; RD 5.2 [1.1-9.4]) and antidepressive drugs (RR 1.90 [1.55-2.32]; RD 3.1 [2.0-4.3]). Being prescribed ≥10 drugs during 1 year incurred an increased risk of hip fracture, whereas prescription of cardiovascular drugs or ≤5 drugs did not appear to increase risk. Diseases inferring the greatest PARs included: cardiovascular diseases PAR 22 % (95 % CI 14-29) and previous injuries (PAR 21 % [95 % CI 16-25]; for specific drugs, antidepressants posed the greatest risk (PAR 16 % [95 % CI 12.0-19.3]).
Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Huddinge, Sweden. breiffni.leavy@ki.se.|Stockholms Sjukhem Foundation, Stockholm, Sweden. breiffni.leavy@ki.se.
Breiffni
0000-0002-9469-6410
B
Leavy
Department of Surgical Sciences, Orthopedics, Uppsala University, Uppsala, Sweden.
Karl
K
Michaëlsson
Department of Public Health and Caring Sciences, Geriatrics, Uppsala University, Uppsala, Sweden.|School of Education, Health and Social Studies, Dalarna University, Falun, Sweden.
Anna Cristina
AC
Åberg
Department of Medical Sciences, Osteoporosis and Clinical Pharmacogenetics, Uppsala University, Uppsala, Sweden.
Håkan
H
Melhus
Department of Surgical Sciences, Orthopedics, Uppsala University, Uppsala, Sweden.
Liisa
L
Byberg
D000368:Aged; D000369:Aged, 80 and over; D000928:Antidepressive Agents / Q000009:adverse effects; D000978:Antiparkinson Agents / Q000009:adverse effects; D002318:Cardiovascular Diseases / Q000150:complications; D015331:Cohort Studies; D006620:Hip Fractures / Q000150:complications / Q000453:epidemiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D015995:Prevalence; D018570:Risk Assessment; D012307:Risk Factors
D000928:Antidepressive Agents; D000978:Antiparkinson Agents
Disease; Dispensed drugs; Hip fracture; Population-based cohort; Risk estimates
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