title: Incident atrial fibrillation and the risk of fracture in the cardiovascular health study.
abstract: In this prospective cohort of 4462 older adults, incident atrial fibrillation (AF) was not statistically significantly associated with subsequent risk of incident fracture.
  
  
  
  AF is associated with stroke, heart failure, dementia, and death, but its association with fracture is unknown. Therefore, we examined the association of incident AF with the risk of subsequent fracture in the Cardiovascular Health Study (CHS) cohort.
  
  
  
  Of the CHS participants aged ≥65 years, 4462 were followed between 1991 and 2009, mean follow-up 8.8 years. Incident AF was identified by annual study electrocardiogram (ECG), hospital discharge diagnosis codes, or Medicare claims. Fractures of the hip, distal forearm, humerus, or pelvis were identified using hospital discharge diagnosis codes or Medicare claims. We used Cox proportional hazard models to estimate hazard ratios (HRs) and 95 % confidence intervals (CIs) for the association between incident AF (time-varying) and the risk of subsequent fracture. We also evaluated whether AF was associated with risk of sustaining a fall.
  
  
  
  Crude incident fracture rate was 22.9 per 1000 person-years in participants with AF and 17.7 per 1000 person-years in participants without AF. Individuals with incident AF were not at significantly higher risk of hip fracture (adjusted HR = 1.09, 95 % CI 0.83-1.42) or fracture at any selected site (adjusted HR = 0.97, 95 % CI 0.77-1.22) or risk of sustaining a fall (adjusted HR = 1.00, 95 % CI = 0.87-1.16) compared with those without AF.
  
  
  
  In this cohort of older, community-dwelling adults, incident AF was not shown to be associated with falls or hip or other fractures.
authors.affiliation: Center for Child Health, Behavior, and Development, Seattle Children's Research Institute, 2001 Eighth Ave, Suite 400, Seattle, WA, 98121, USA. Erin.Wallace@seattlechildrens.org.
authors.forename: E R
authors.initials: ER
authors.lastname: Wallace
authors.affiliation: New York Academy of Medicine, New York, NY, USA.|Department of Medicine, University of Washington, Seattle, WA, USA.|Department of Epidemiology, University of Washington, Seattle, WA, USA.
authors.forename: D S
authors.initials: DS
authors.lastname: Siscovick
authors.affiliation: Department of Medicine, University of Washington, Seattle, WA, USA.
authors.forename: C M
authors.initials: CM
authors.lastname: Sitlani
authors.affiliation: Department of Epidemiology, University of Washington, Seattle, WA, USA.|Group Health Cooperative, Group Health Research Institute, Seattle, WA, USA.
authors.forename: S
authors.initials: S
authors.lastname: Dublin
authors.affiliation: School of Nursing, University of Washington, Seattle, WA, USA.
authors.forename: P
authors.initials: P
authors.lastname: Mitchell
authors.affiliation: University of California, Davis, Davis, CA, USA.
authors.forename: J A
authors.initials: JA
authors.lastname: Robbins
authors.affiliation: Geriatric Research Education and Clinical Center, VA Health Care System, Minneapolis, MN, USA.|Department of Medicine, University of Minnesota, Minneapolis, MN, USA.
authors.forename: H A
authors.initials: HA
authors.lastname: Fink
authors.affiliation: Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA.
authors.forename: J A
authors.initials: JA
authors.lastname: Cauley
authors.affiliation: Department of Biostatistics, University of Washington, Seattle, WA, USA.
authors.forename: P
authors.initials: P
authors.lastname: Bůžková
authors.affiliation: Medical College of Georgia at Augusta University, Augusta, GA, USA.
authors.forename: L
authors.initials: L
authors.lastname: Carbone
authors.affiliation: University of Arizona, Tucson, AZ, USA.
authors.forename: Z
authors.initials: Z
authors.lastname: Chen
authors.affiliation: Department of Epidemiology, University of Washington, Seattle, WA, USA.|Group Health Cooperative, Group Health Research Institute, Seattle, WA, USA.
authors.forename: S R
authors.initials: SR
authors.lastname: Heckbert
mesh_terms: D000058:Accidental Falls / Q000706:statistics & numerical data; D000368:Aged; D001281:Atrial Fibrillation / Q000453:epidemiology*; D015897:Comorbidity; D005260:Female; D006620:Hip Fractures / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D008137:Longitudinal Studies; D008297:Male; D058866:Osteoporotic Fractures / Q000453:epidemiology*; D011446:Prospective Studies; D012307:Risk Factors; D014481:United States / Q000453:epidemiology
keywords: Arrhythmia; Atrial fibrillation; Fracture; Hip fracture