Osteoporosis International

, Volume 25, Issue 1, pp 97–103 | Cite as

Association between hypertension and fragility fracture: a longitudinal study

  • S. Yang
  • N. D. Nguyen
  • J. R. Center
  • J. A. Eisman
  • T. V. NguyenEmail author
Original Article



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


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.


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.


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.


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


Bone mineral density Fracture risk Hypertension Osteoporosis 



The work was not supported by any funding body. The Dubbo Osteoporosis Epidemiology Study was supported in part by the National Health and Medical Research Council (NHMRC) grant 276413. This study also received support from the MBF Living Well Foundation; the Ernst Heine Foundation; and untied grants from Amgen, Merck Sharp & Dohme, Sanofi-Aventis, Servier, and Novartis. We thank Janet Watters, Sue Boyd, Carol Gilbert, Angie Ferguson, Di Conn, Donna Reeves, Shaye Field, Glenys Hubbard, and Sharon Erockson of Garvan Institute of Medical Research in Dubbo for data collection.

Conflicts of interest



  1. 1.
    Kearney PM, Whelton M, Reynolds K, Muntner P, Whelton PK, He J (2005) Global burden of hypertension: analysis of worldwide data. Lancet 365:217–223PubMedGoogle Scholar
  2. 2.
    Marina RP, Ivan T (2009) Association between hypertension and osteoporosis in postmenopausal women. Acta Med Medianae 48:8–13Google Scholar
  3. 3.
    Epstein M (1994) Hypertension as a risk factor for progression of chronic renal disease. Blood Press Suppl 1:23–28PubMedGoogle Scholar
  4. 4.
    Kannel WB (1993) Hypertension as a risk factor for cardiac events—epidemiologic results of long-term studies. J Cardiovasc Pharmacol 21(Suppl 2):S27–S37PubMedCrossRefGoogle Scholar
  5. 5.
    Petrov-Kiurski M (1993) [Arterial hypertension as a risk factor in ischemic heart disease]. Arterijska hipertenzija kao faktor rizika u ishemijskoj bolesti srca. Med Pregl 46:31–34PubMedGoogle Scholar
  6. 6.
    Hernandez-Hernandez R, Armas-Padilla MC, Armas-Hernandez MJ, Velasco M (1998) The prevalence of hypertension and the state of cardiovascular health in Venezuela and surrounding nations. Ethn Dis 8:398–405PubMedGoogle Scholar
  7. 7.
    Ferguson GT, Calverley PM, Anderson JA, Jenkins CR, Jones PW, Willits LR, Yates JC, Vestbo J, Celli B (2009) Prevalence and progression of osteoporosis in patients with COPD: results from the TOwards a Revolution in COPD Health study. Chest 136:1456–1465PubMedCrossRefGoogle Scholar
  8. 8.
    Klotzbuecher CM, Ross PD, Landsman PB, Abbott TA 3rd, Berger M (2000) Patients with prior fractures have an increased risk of future fractures: a summary of the literature and statistical synthesis. J Bone Miner Res 15:721–739PubMedCrossRefGoogle Scholar
  9. 9.
    Nguyen ND, Ahlborg HG, Center JR, Eisman JA, Nguyen TV (2007) Residual lifetime risk of fractures in women and men. J Bone Miner Res 22:781–788PubMedCrossRefGoogle Scholar
  10. 10.
    Ben Sedrine W, Radican L, Reginster JY (2001) On conducting burden-of-osteoporosis studies: a review of the core concepts and practical issues. A study carried out under the auspices of a WHO Collaborating Center. Rheumatology (Oxford) 40:7–14CrossRefGoogle Scholar
  11. 11.
    Cummings SR, Nevitt MC, Browner WS, Stone K, Fox KM, Ensrud KE, Cauley J, Black D, Vogt TM (1995) Risk factors for hip fracture in white women. Study of Osteoporotic Fractures Research Group. N Engl J Med 332:767–773PubMedCrossRefGoogle Scholar
  12. 12.
    Kannel WB (1989) Risk factors in hypertension. J Cardiovasc Pharmacol 13(Suppl 1):S4–S10PubMedCrossRefGoogle Scholar
  13. 13.
    MacGregor GA, Cappuccio FP (1993) The kidney and essential hypertension: a link to osteoporosis? J Hypertens 11:781–785PubMedCrossRefGoogle Scholar
  14. 14.
    Gadallah M, Massry SG, Bigazzi R, Horst RL, Eggena P, Campese VM (1991) Intestinal absorption of calcium and calcium metabolism in patients with essential hypertension and normal renal function. Am J Hypertens 4:404–409PubMedCrossRefGoogle Scholar
  15. 15.
    Young EW, Morris CD, McCarron DA (1992) Urinary calcium excretion in essential hypertension. J Lab Clin Med 120:624–632PubMedGoogle Scholar
  16. 16.
    Cappuccio FP, Meilahn E, Zmuda JM, Cauley JA (1999) High blood pressure and bone-mineral loss in elderly white women: a prospective study. Study of Osteoporotic Fractures Research Group. Lancet 354:971–975PubMedCrossRefGoogle Scholar
  17. 17.
    Tsuda K, Nishio I, Masuyama Y (2001) Bone mineral density in women with essential hypertension. Am J Hypertens 14:704–707PubMedCrossRefGoogle Scholar
  18. 18.
    Vestergaard P, Rejnmark L, Mosekilde L (2009) Hypertension is a risk factor for fractures. Calcif Tissue Int 84:103–111PubMedCrossRefGoogle Scholar
  19. 19.
    Sennerby U, Melhus H, Gedeborg R, Byberg L, Garmo H, Ahlbom A, Pedersen NL, Michaelsson K (2009) Cardiovascular diseases and risk of hip fracture. JAMA 302:1666–1673PubMedCrossRefGoogle Scholar
  20. 20.
    Perez-Castrillon JL, Martin-Escudero JC, Alvarez Manzanares P, Cortes Sancho R, Iglesias Zamora S, Garcia Alonso M (2005) Hypertension as a risk factor for hip fracture. Am J Hypertens 18:146–147PubMedCrossRefGoogle Scholar
  21. 21.
    Simons LA, McCallum J, Simons J, Powell I, Ruys J, Heller R, Lerba C (1990) The Dubbo study: an Australian prospective community study of the health of elderly. Aust N Z J Med 20:783–789PubMedCrossRefGoogle Scholar
  22. 22.
    Kannel WB, Sorlie P, Kannel WB, Sorlie P (1979) Some health benefits of physical activity. The Framingham Study. Arch Intern Med 139:857–861PubMedCrossRefGoogle Scholar
  23. 23.
    Angus RM, Sambrook PN, Pocock NA, Eisman JA (1989) A simple method for assessing calcium intake in Caucasian women. J Am Diet Assoc 89:209–214PubMedGoogle Scholar
  24. 24.
    Nguyen ND, Frost SA, Center JR, Eisman JA, Nguyen TV (2008) Development of prognostic nomograms for individualizing 5-year and 10-year fracture risks. Osteoporos Int 19:1431–1444PubMedCrossRefGoogle Scholar
  25. 25.
    Nguyen T, Sambrook P, Kelly P, Jones G, Lord S, Freund J, Eisman J (1993) Prediction of osteoporotic fractures by postural instability and bone density. BMJ 307:1111–1115PubMedCrossRefGoogle Scholar
  26. 26.
    McCarron DA, Pingree PA, Rubin RJ, Gaucher SM, Molitch M, Krutzik S (1980) Enhanced parathyroid function in essential hypertension: a homeostatic response to a urinary calcium leak. Hypertension 2:162–168PubMedCrossRefGoogle Scholar
  27. 27.
    Strazzullo P, Nunziata V, Cirillo M, Giannattasio R, Ferrara LA, Mattioli PL, Mancini M (1983) Abnormalities of calcium metabolism in essential hypertension. Clin Sci (Lond) 65:137–141Google Scholar
  28. 28.
    Cappuccio FP, Kalaitzidis R, Duneclift S, Eastwood JB (2000) Unravelling the links between calcium excretion, salt intake, hypertension, kidney stones and bone metabolism. J Nephrol 13:169–177PubMedGoogle Scholar
  29. 29.
    Rosano C, Longstreth WT Jr, Boudreau R, Taylor CA, Du Y, Kuller LH, Newman AB (2011) High blood pressure accelerates gait slowing in well-functioning older adults over 18-years of follow-up. J Am Geriatr Soc 59:390–397PubMedCentralPubMedCrossRefGoogle Scholar
  30. 30.
    Bergland A, Jarnlo G-B, Laake K (2003) Predictors of falls in the elderly by location. Aging Clin Exp Res 15:43–50PubMedCrossRefGoogle Scholar
  31. 31.
    Hajjar I, Kotchen TA (2003) Trends in prevalence, awareness, treatment, and control of hypertension in the United States, 1988–2000. JAMA 290:199–206PubMedCrossRefGoogle Scholar
  32. 32.
    Kanis JA (2007) WHO technical report. University of Sheffield, SheffieldGoogle Scholar
  33. 33.
    Popovic MR, Tasic I (2009) Association between hypertension and osteoporosis in postmenopausal women. Acta Med Medianae 48:8–13Google Scholar

Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2013

Authors and Affiliations

  • S. Yang
    • 1
    • 2
  • N. D. Nguyen
    • 1
  • J. R. Center
    • 1
    • 5
  • J. A. Eisman
    • 1
    • 3
    • 4
    • 5
  • T. V. Nguyen
    • 1
    • 2
    • 3
    Email author
  1. 1.Division of Musculoskeletal DiseasesGarvan Institute of Medical ResearchSydneyAustralia
  2. 2.School of Public Health & Community MedicineUniversity of New South WalesSydneyAustralia
  3. 3.St. Vincent’s Clinical SchoolUniversity of New South WalesSydneyAustralia
  4. 4.School of MedicineThe University of Notre Dame AustraliaFremantleAustralia
  5. 5.Department of EndocrinologySt. Vincent’s HospitalSydneyAustralia

Personalised recommendations