Osteoporosis International

, Volume 28, Issue 2, pp 719–725 | Cite as

Incident atrial fibrillation and the risk of fracture in the cardiovascular health study

  • E. R. Wallace
  • D. S. Siscovick
  • C. M. Sitlani
  • S. Dublin
  • P. Mitchell
  • J. A. Robbins
  • H. A. Fink
  • J. A. Cauley
  • P. Bůžková
  • L. Carbone
  • Z. Chen
  • S. R. Heckbert
Short Communication



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.


Arrhythmia Atrial fibrillation Fracture Hip fracture 



This research was supported by contracts HHSN268201200036C, HHSN268200800007C, N01 HC55222, N01HC85079, N01HC85080, N01HC85081, N01HC85082, N01HC85083, and N01HC85086 and grants HL080295 and HL102214 from the National Heart, Lung, and Blood Institute (NHLBI), with additional contribution from the National Institute of Neurological Disorders and Stroke (NINDS). Additional support was provided by AG023629 from the National Institute on Aging (NIA). A full list of principal CHS investigators and institutions can be found at CHS-NHLBI.org. Erin Wallace was supported by a NHLBI I-T32-HL07902 training grant. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Compliance with ethical standards

Conflicts of interest


Supplementary material

198_2016_3778_MOESM1_ESM.docx (28 kb)
Supplementary Figure 1 (DOCX 28 kb)
198_2016_3778_MOESM2_ESM.docx (22 kb)
Supplementary Table 1 (DOCX 22 kb)


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Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2016

Authors and Affiliations

  • E. R. Wallace
    • 1
  • D. S. Siscovick
    • 2
    • 3
    • 4
  • C. M. Sitlani
    • 3
  • S. Dublin
    • 4
    • 5
  • P. Mitchell
    • 6
  • J. A. Robbins
    • 7
  • H. A. Fink
    • 8
    • 9
  • J. A. Cauley
    • 10
  • P. Bůžková
    • 11
  • L. Carbone
    • 12
  • Z. Chen
    • 13
  • S. R. Heckbert
    • 4
    • 5
  1. 1.Center for Child Health, Behavior, and DevelopmentSeattle Children’s Research InstituteSeattleUSA
  2. 2.New York Academy of MedicineNew YorkUSA
  3. 3.Department of MedicineUniversity of WashingtonSeattleUSA
  4. 4.Department of EpidemiologyUniversity of WashingtonSeattleUSA
  5. 5.Group Health CooperativeGroup Health Research InstituteSeattleUSA
  6. 6.School of NursingUniversity of WashingtonSeattleUSA
  7. 7.University of California, DavisDavisUSA
  8. 8.Geriatric Research Education and Clinical CenterVA Health Care SystemMinneapolisUSA
  9. 9.Department of MedicineUniversity of MinnesotaMinneapolisUSA
  10. 10.Department of Epidemiology, Graduate School of Public HealthUniversity of PittsburghPittsburghUSA
  11. 11.Department of BiostatisticsUniversity of WashingtonSeattleUSA
  12. 12.Medical College of Georgia at Augusta UniversityAugustaUSA
  13. 13.University of ArizonaTucsonUSA

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