Cardiovascular Diseases and Osteoporotic Fractures: A Vicious Cycle

New research revealed that elderly patients in United Kingdom who were at higher risk of fractures due to either osteoporosis or prior fractures were also more prone to major adverse cardiovascular events (MACE). The findings of the study are published in the Journal of Bone and Mineral Research.

“Cardiovascular disease and osteoporosis are both leading causes of morbidity and mortality worldwide and their prevalence increases with age,” the researchers explained. “To address this issue, our overarching aim was to assess the absolute risk of cardiovascular disease experienced by elderly patients at higher fracture risk in the UK, as well as to identify key risk factors (both generic and specific ones) for these patients.”

To estimate the incidence rate of cardiovascular disease events namely stroke, myocardial infarction and death, at 1 year, the investigators grouped the patients into 3 cohorts based on high risk of fracture due to osteoporosis, previous fracture, or treatment with antiosteoporosis medication.

Obtaining data from the Clinical Practice Research Datalink, a primary care database in the UK, the team identified the key risk factors of cardiovascular disease events among patients based on the following factors:

• recently diagnosed with osteoporosis (OST, n = 65,295)
• incident fragility fracture (IFX, n = 67,065)
• starting oral bisphosphonatesx (OBP, n = 145,959).

General contributors to MACE among all patients were sex; age; smoking; alcohol use; atrial fibrillation; antihypertensive medication; history of myocardial infarction and stroke; pre-existing cardiovascular diseases; glomerular filtration rate; systolic blood pressure; cholesterol levels; and number of concomitant medicines, the team noted.

More specifically, the IFX cohort experienced a significant number of MACE events at 4.39%, compared to 2.38% of patients in OBP group and 1.90% of patients in OST group. MACE incidence rates per 1000 cases was also the highest in IFX group (52.64) vs 19.63 in OST and 26.26 in OBP.

Additionally, the study assessed that the incidence of MACE was slightly higher at 1 year than at 2 years, especially for the IFX cohort and was higher for men than for women. The incidence rates increased with age—patients more than 75 years of age were more prone to MACE—higher comorbid conditions, and higher prevalence of concomitant drugs.

“To summarize, incidence rate of MACE events in the studied populations ranged from 19.6 to 52.6, with IFX as the cohort with the higher risk. Efforts in predicting the study events outline the differences between general and the osteoporotic/fracture risk population,” the researchers advised. “The resulting algorithms include risk factors specific to the study population as well as more generic features that can be found easily in primary care data.”

—Priyam Vora

Reference:
Moncusi M, Hussein L, Delmestri A et al. Estimating the incidence and key risk factors of cardiovascular disease in patients at high risk of imminent fracture using routinely collected real-world data from the UK. J Bone Miner Res. Published online: July 11, 2022. DOI: https://doi.org/10.1002/jbmr.4648