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Risk and outcomes of fracture in peripheral arterial disease patients: two nationwide cohort studies

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Abstract

Summary

Using national insurance claims data of Taiwan, we found that patients with peripheral arterial disease (PAD) had increased risk of fracture during the follow-up period of 2000–2013. History of PAD was also associated with adverse outcomes in hospitalized fracture patients. Prevention strategies were needed in this susceptible population.

Introduction

Limited information was available on the association between PAD and fracture. The purpose of this study is to evaluate fracture risk and post-fracture outcomes in patients with PAD.

Methods

We identified 6647 adults aged ≥ 20 years with newly diagnosed PAD using the Taiwan National Health Insurance Research Database in 2000–2004. Comparison cohort consisted of 26,588 adults without PAD randomly selected with frequency matching in age and sex. Events of fracture were identified during the follow-up period from January 1, 2000 until December 31, 2013, to evaluate adjusted hazard ratios (HR) and 95% confidence interval (CI) of fracture associated with PAD. Another nested cohort study of 799,463 hospitalized fracture patients analyzed adjusted odds ratios (ORs) and 95% CIs of adverse events after fracture among patients with and without PAD in 2004–2013.

Results

Incidences of fracture in people with and without PAD were 22.1 and 15.5 per 1000 person-years, respectively (P < .0001). Compared with control, the adjusted HR of fracture was 1.59 (95% CI, 1.48–1.69) for PAD patients. In the nested cohort study, patients with PAD had higher post-fracture mortality (OR = 1.16; 95% CI, 1.09–1.25) and various complications. PAD patients also had comparatively higher medical expenditure (2691 vs. 2232 USD, P < .0001) and longer hospital stay (10.6 vs. 9.0 days, P < 0.0001) during fracture admission.

Conclusions

Increased risk of fracture and post-fracture adverse outcomes were associated with PAD. This susceptible population needs care to prevent fracture and to minimize adverse outcomes after it occurs.

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Abbreviations

ICD-9-CM:

International Classification of Diseases, 9th Revision, Clinical Modification

CI:

Confidence interval

HR:

Hazard ratio

OR:

Odds ratio

PAD:

Peripheral arterial disease

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Acknowledgements

This study is based in part on data obtained from the National Health Insurance Research Database. This database is provided by the National Health Insurance Administration of Taiwan’s Ministry of Health and Welfare and is managed by the National Health Research Institutes. The authors’ interpretations and conclusions do not represent those of the aforementioned agencies.

Funding Information

This study was supported in part by grants from Taiwan’s Ministry of Science and Technology (MOST105-2629-B-038-001, MOST105-2221-E-038-014, MOST105-2314-B-038-025, MOST104-2314-B-038-027-MY2, NSC102-2314-B-038-021-MY3), Shuang Ho Hospital, Taipei Medical University (104TMU-SHH-23), and Taiwan’s Ministry of Health and Welfare Clinical Trial and Research Center of Excellence (MOHW106-TDUB-212-113004)

Author information

Author notes

  1. Ta-Liang Chen has equal contribution with the corresponding author.

Authors and Affiliations

  1. Department of Anesthesiology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan

    F.-L. Liu, Y.-G. Cherng & C.-C. Liao

  2. Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan

    F.-L. Liu, C.-S. Lin, Y.-G. Cherng, T.-L. Chen & C.-C. Liao

  3. Department of Anesthesiology, Taipei Medical University Hospital, 252 Wuxing St., Taipei, 110, Taiwan

    C.-S. Lin, T.-L. Chen & C.-C. Liao

  4. Health Policy Research Center, Taipei Medical University Hospital, Taipei, Taiwan

    C.-S. Lin, T.-L. Chen & C.-C. Liao

  5. Department of Surgery, China Medical University Hospital, China Medical University, Taichung, Taiwan

    C.-C. Yeh

  6. Department of Surgery, University of Illinois, Chicago, IL, USA

    C.-C. Yeh

  7. School of Chinese Medicine for Post-Baccalaureate, I-Shou University, Kaohsiung, Taiwan

    C.-C. Shih

  8. Department of Family Medicine, National Cheng Kung University Hospital, Tainan, Taiwan

    C.-H. Wu

  9. School of Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung, Taiwan

    C.-C. Liao

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  1. F.-L. Liu
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Corresponding author

Correspondence to C.-C. Liao.

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Conflicts of interest

Feng-Lin Liu, Chao-Shun Lin, Chun-Chieh Yeh, Chun-Chuan Shih, Yih-Giun Cherng, Chih-Hsing Wu, Ta-Liang Chen, and Chien-Chang Liao declare that they have no conflict of interest.

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Liu, FL., Lin, CS., Yeh, CC. et al. Risk and outcomes of fracture in peripheral arterial disease patients: two nationwide cohort studies. Osteoporos Int 28, 3123–3133 (2017). https://doi.org/10.1007/s00198-017-4192-z

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  • DOI: https://doi.org/10.1007/s00198-017-4192-z

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