Original Article

Osteoporosis International

, Volume 25, Issue 1, pp 97-103

Association between hypertension and fragility fracture: a longitudinal study

  • S. YangAffiliated withDivision of Musculoskeletal Diseases, Garvan Institute of Medical ResearchSchool of Public Health & Community Medicine, University of New South Wales
  • , N. D. NguyenAffiliated withDivision of Musculoskeletal Diseases, Garvan Institute of Medical Research
  • , J. R. CenterAffiliated withDivision of Musculoskeletal Diseases, Garvan Institute of Medical ResearchDepartment of Endocrinology, St. Vincent’s Hospital
  • , J. A. EismanAffiliated withDivision of Musculoskeletal Diseases, Garvan Institute of Medical ResearchSt. Vincent’s Clinical School, University of New South WalesSchool of Medicine, The University of Notre Dame AustraliaDepartment of Endocrinology, St. Vincent’s Hospital
  • , T. V. NguyenAffiliated withDivision of Musculoskeletal Diseases, Garvan Institute of Medical ResearchSchool of Public Health & Community Medicine, University of New South WalesSt. Vincent’s Clinical School, University of New South Wales Email author 

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Abstract

Summary

Hypertension is an independent risk factor for osteoporosis and osteoporotic fracture in postmenopausal women.

Introduction

Although hypertension has been suggested to be associated with increased fracture risk, it is not clear whether the association is independent of bone mineral density (BMD). The present study sought to examine the interrelationships between hypertension, BMD, and fracture risk.

Methods

The study included 1,032 men and 1,701 women aged 50 years and older who were participants in the Dubbo Osteoporosis Epidemiology Study. BMD at the femoral neck and lumbar spine was measured by dual energy X-ray absorptiometry (GE-LUNAR Corp., Madison, WI, USA). The presence of hypertension was ascertained by direct interview and verification through clinical history. The incidence of fragility fractures was ascertained by X-ray report during the follow-up period (1989–2008). The Cox proportional hazards model was used to assess the association between hypertension and fracture risk.

Results

Women with hypertension had lower BMD at the femoral neck (0.79 versus 0.82 g/cm2, P = 0.02) than those without the disease. After adjusting for BMD and covariates, hypertension was an independent risk factor for fragility fracture [hazard ratio (HR), 1.49; 95 % CI, 1.13–1.96]. In men, hypertension was associated with higher femoral neck BMD (0.94 versus 0.92 g/cm2, P = 0.02), but the association between hypertension and fracture risk did not reach statistical significance.

Conclusion

Hypertension is associated with increased fracture risk in women, and the association is independent of BMD.

Keywords

Bone mineral density Fracture risk Hypertension Osteoporosis