title: Comparison of predictors of hip fracture and mortality after hip fracture in community-dwellers with and without Alzheimer's disease - exposure-matched cohort study.
abstract: Dementia, with Alzheimer's disease (AD) being the most common form, is a major hip fracture risk factor, but currently it is not known whether the same factors predict hip fracture among persons with and without dementia/AD. We compared the predictors of hip fracture and mortality after hip fracture in persons with and without AD.
  
  
  
  An exposure-matched cohort of all community-dwellers of Finland who received a new clinically verified AD diagnosis in 2005-2011 and had no history of previous hip fracture (N = 67,072) and an age, sex, and region-matched cohort of persons without AD (N = 67,072). Associations between sociodemographic characteristics, comorbidities and medications and risk of hip fracture and mortality after hip fracture were assessed with Cox regression.
  
  
  
  As expected, the incidence of hip fractures in 2005-2012 (2.19/100 person-years vs 0.90/100 person-years in the non-AD cohort), as well as mortality after hip fracture (29/100 person-years vs 23/100 person-years in the non-AD cohort) were higher in the AD cohort. This difference was evident regardless of the risk factors. Mental and behavioural disorders (adjusted hazard ratio; HR 95% confidence interval CI: 1.16, 1.09-1.24 and 1.71, 1.52-1.92 in the AD and non-AD-cohorts), antipsychotics (1.12, 1.04-1.20 and 1.56, 1.38-1.76 for AD and non-AD-cohorts) and antidepressants (1.06, 1.00-1.12 and 1.34 1.22-1.47 for AD and non-AD-cohorts) were related to higher, and estrogen/combination hormone therapy (0.87, 0.77-0.9 and 0.79, 0.64-0.98 for AD and non-AD-cohorts) to lower hip fracture risk in both cohorts. Stroke (1.42, 1.26-1.62), diabetes (1.13, 0.99-1.28), active cancer treatment (1.67, 1.22-2.30), proton pump inhibitors (1.14, 1.05-1.25), antiepileptics (1.27, 1.11-1.46) and opioids (1.10, 1.01-1.19) were associated with higher hip fracture risk in the non-AD cohort. Similarly, the associations between mortality risk factors (age, sex, several comorbidities and medications) were stronger in the non-AD cohort.
  
  
  
  AD itself appears to be such a significant risk factor for hip fracture, and mortality after hip fracture, that it overrules or diminishes the effect of other risk factors. Thus, it is important to develop and implement preventive interventions that are suitable and effective in this population.
authors.affiliation: School of Pharmacy, University of Eastern Finland, PO Box 1627, 70211, Kuopio, Finland. anna-maija.tolppanen@uef.fi.|Research Centre for Comparative Effectiveness and Patient Safety (RECEPS), University of Eastern Finland, PO Box 1627, 70211, Kuopio, Finland. anna-maija.tolppanen@uef.fi.
authors.forename: Anna-Maija
authors.identifier: 0000-0001-9270-9268
authors.initials: AM
authors.lastname: Tolppanen
authors.affiliation: School of Pharmacy, University of Eastern Finland, PO Box 1627, 70211, Kuopio, Finland.|Kuopio Research Centre of Geriatric Care, University of Eastern Finland, PO Box 1627, 70211, Kuopio, Finland.|Department of Forensic Psychiatry, Niuvanniemi Hospital, 70240, Kuopio, Finland.|Department of Clinical Neuroscience, (CNS), K8, CPF Tiihonen, R5:00, Cpf, Karolinska Universitetssjukhuset Solna 171 76, Stockholm, Sweden.
authors.forename: Heidi
authors.initials: H
authors.lastname: Taipale
authors.affiliation: Department of Forensic Psychiatry, Niuvanniemi Hospital, 70240, Kuopio, Finland.|Department of Clinical Neuroscience, (CNS), K8, CPF Tiihonen, R5:00, Cpf, Karolinska Universitetssjukhuset Solna 171 76, Stockholm, Sweden.|National Institute for Health and Welfare, PO Box 30, 00271, Helsinki, Finland.
authors.forename: Antti
authors.initials: A
authors.lastname: Tanskanen
authors.affiliation: Department of Forensic Psychiatry, Niuvanniemi Hospital, 70240, Kuopio, Finland.|Department of Clinical Neuroscience, (CNS), K8, CPF Tiihonen, R5:00, Cpf, Karolinska Universitetssjukhuset Solna 171 76, Stockholm, Sweden.
authors.forename: Jari
authors.initials: J
authors.lastname: Tiihonen
authors.affiliation: School of Pharmacy, University of Eastern Finland, PO Box 1627, 70211, Kuopio, Finland.|Kuopio Research Centre of Geriatric Care, University of Eastern Finland, PO Box 1627, 70211, Kuopio, Finland.|Department of Psychiatry, Kuopio University Hospital, PO Box 100, 70029, Kuopio, Finland.
authors.forename: Sirpa
authors.initials: S
authors.lastname: Hartikainen
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000453:epidemiology*; D015984:Causality; D015331:Cohort Studies; D015897:Comorbidity; D003710:Demography; D005260:Female; D005387:Finland / Q000453:epidemiology; D006620:Hip Fractures / Q000453:epidemiology / Q000401:mortality; D006801:Humans; D015994:Incidence; D057187:Independent Living / Q000706:statistics & numerical data*; D008297:Male; D016016:Proportional Hazards Models; D012307:Risk Factors; D012959:Socioeconomic Factors
keywords: Alzheimer’s disease; Cohort study; Hip fracture; Mortality; Risk factors