Abstract
Summary
The aim of the present study was to assess whether peripheral arterial disease is associated with an increased risk of hip fracture in a cohort of 12,094 older men. There was no association between claudication and hip fracture, but there was a significant association with an ankle brachial index (ABI) <0.9.
Introduction
It is uncertain whether peripheral arterial disease (PAD) is associated with an increased risk of subsequent hip fracture. The aim of the present study was to assess this in a large cohort of men aged 65 years and over.
Methods
Claudication was assessed by means of the Edinburgh Claudication Questionnaire in 12,094 men, and the ABI was measured in 4,321 of these men. Hospitalisations with hip fracture were identified by record linkage. The association between both claudication and an ABI <0.9 and subsequent hip fractures was assessed using survival curves and Cox regression models.
Results
Amongst the 12,094 men, the baseline prevalence of claudication according to the ECQ was 5.3 %. Amongst the 4,321 men with ABI results, the prevalence of an ABI <0.9 was 11.7 %. Of the 506 men with an ABI <0.9, 129 (25.5 %) also had claudication. Over a median (range) follow-up of 10.8 (0.3–12.7) years, 343 (2.8 %) of the 12,094 men were admitted to hospital with a hip fracture. There was no association between claudication and subsequent hip fractures (hazard ratio (HR) = 0.95; 95 % confidence interval (CI), 0.60, 1.52). Over a median (range) follow-up of 11.1 (0.06–12.3) years 135 (3.1 %) of the 4,321 men with ABI data were admitted to hospital with hip fractures. There was a significant association between an ABI <0.9 and subsequent hip fracture (HR = 1.69; 95 % CI, 1.08, 2.63).
Conclusion
Older men with PAD defined as ABI < 0.9 are at increased risk of hip fracture, whereas the symptom of claudication is not an independent predictor of hip fracture.
Similar content being viewed by others
References
Anagnostis P, Karagiannis A, Kakfika AI, Tziomalos K, Athyros VG, Mikhailidis DP (2009) Atherosclerosis and osteoporosis:age-dependent degenerative process or related entities? Osteoporos Int 20:197–207
den Uyl D, Nurmohamen MT, van Tuyl LHD, Raterman HG, Lems WF (2011) (Sub) clinical cardiovascular disease is associated with increased bone loss and fracture risk; a systematic review of the association between cardiovascular disease and osteoporosis. Arthritis Res Ther 2:R5
Farhat GN, Newman AB, Sutton-Tyrell K, Mathews KA, Boudreau R, Schwartz AV et al (2007) The association of bone mineral density measures with incident cardiovascular disease in older adults. Osteoporos Int 18:999–1008
Szulc P, Kiel DP, Delmas PD (2008) Calcifications in the abdominal aorta predict fractures in Men: MINOS Study. JBMR 23:95–102
Sennerby U, Melhus H, Gedeborg R, Byberg L, Garmo H, Ahlbom A et al (2009) Cardiovascular diseases and risk of hip fracture. JAMA 302:1666–1673
McDermott MM, Greenland P, Liu K, Guralnik JM, Criqui MH, Dolan NC et al (2001) Leg symptoms in peripheral arterial disease. Associated clinical characteristics and functional impairment. JAMA 286:1599–1606
Mangiafico RA, Russo E, Riccobene S, Pennisi P, Mangiafico M, D’Amico F et al (2006) Increased prevalence of peripheral arterial disease in osteoporotic potmenopausal women. J Bone Miner Metab 24:125–131
van der Klift M, Pols HAP, Hak AE, Witteman JCM, Hofman A, de Laet CEDH (2002) Bone mineral density and the risk of peripheral arterial disease: The Rotterdam Study. Calcif Tissue Int 70:443–449
Wong SYS, Kwok T, Woo J, Lynn H, Griffith JF, Leung J et al (2005) Bone mineral density and the risk of peripheral arterial disease in men and women: results from Mr. and Ms Os, Hong Kong. Osteoporos Int 16:1933–1938
Collins TC, Ewing SK, Diem SJ, Taylor BC, Orwoll ES, Cummings SR et al (2009) Peripheral arterial disease is associated with higher rates of hip bone loss and increased fracture risk in older men. Circulation 119:2305–2312
von Muhle D, Allison M, Jassal SK, Barrett-Connor E (2009) Peripheral arterial disease and osteoporosis in older adults: the Rancho Bernado Study. Osteoporos Int 20:2071–2078
Norman PE, Jamrozik K, Lawrence-Brown MM, Le M, Spencer CA, Tuohy R et al (2004) Population-based randomised controlled trial on impact of screening on mortality from abdominal aortic aneurysm. BMJ 329:1259–1262
Norman PE, Flicker L, Almeida OP, Hankey GJ, Hyde Z, Jamrozik K (2008) Cohort Profile: The Health In Men Study (HIMS). Int J Epidemiol 38:48–52
Holman CD, Bass AJ, Rouse IL, Hobbs MS (1999) Population-based linkage of health records in Western Australia: development of a health services research linked database. Aust N Z J Public Health 23:453–459
Leng GC, Fowkes FGR (1992) The Edinburgh Claudication Questionnaire: an improved version of the WHO/Rose questionnaire for use in epidemiological surveys. J Clin Epidemiol 45:1101–1109
Ankle Brachial Index Collaboration (2008) Ankle brachial index combined with Framingham risk score in prediction of cardiovascular events and mortality in 16 international cohort studies. JAMA 300:197–208
Venning G (2005) Recent developments in vitamin D deficiency and muscle weakness among elderly people. BMJ 330:524–526
Anderson JL, May HT, Horne BD, Bair TL, Hall NL, Carlquist JL et al (2010) Relation of vitamin D deficiency to cardiovascular risk factors, disease status, and incident events in a general healthcare population. Am J Cardiol 106:963–968
Naves M, Rodriguez-Garcia M, Diaz-Lopez JB, Gomez-Alonso C, Cannata-Andia JB (2008) Progression of vascular calcifications is associated with greater bone loss and increased bone fractures. Osteoporos Int 19:1161–1166
McDermott MM, Guralnik JM, Ferrucci L, Tian L, Liu K, Liao Y et al (2008) Asymptomatic peripheral arterial disease is associated with more adverse lower extremity characteristics than intermittent claudication. Circulation 117:2484–2491
Acknowledgments
Special thanks to all the men who participated in the Western Australian Abdominal Aortic Aneurysm Program. Thanks to the staff, investigators and research students involved in the original screening and PAD trials. The authors are also grateful for the assistance received from the State Electoral Commission, the Australian Bureau of Statistics, the Registrar General of Births, Deaths and Marriages, and the Data Linkage Unit of the Health Department of Western Australia, and to hospitals in Perth for providing the space in which to conduct the screening.
Funding sources
The study was funded by research grants from the National Health and Medical Research Council of Australia (NHMRC 964145 and 139093) and the Western Australian Health Promotion Foundation.
Conflicts of interest
None
Author information
Authors and Affiliations
Corresponding author
Electronic supplementary materials
Below is the link to the electronic supplementary material.
ESM 1
(DOC 93 kb)
Rights and permissions
About this article
Cite this article
Hyde, Z., Mylankal, K.J., Hankey, G.J. et al. Peripheral arterial disease increases the risk of subsequent hip fracture in older men: the Health in Men Study. Osteoporos Int 24, 1683–1688 (2013). https://doi.org/10.1007/s00198-012-2218-0
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00198-012-2218-0