Sennerby U et al. (2007) Cardiovascular diseases and future risk of hip fracture in women. Osteoporos Int 18: 1355–1362

Studies have uncovered an association between cardiovascular disease (CVD) and impaired bone mineral metabolism, but it is unknown if a link exists between CVD and osteoporotic fracture. Sennerby et al., therefore, conducted a population-based case–control study in six Swedish counties (total population >4 million) to investigate whether CVD increases the risk of osteoporotic fracture in women.

The study population consisted of 1,327 women aged 50–81 years who suffered a hip fracture between October 1993 and February 1995, and 3,170 matched controls. Fractures due to malignancy or high-energy trauma were excluded. Fracture cases had lower BMI than controls, were more likely to smoke, abstain from alcohol, not to have used hormone replacement therapy, and were less physically active. CVD was present before study entry in 25% of fracture cases versus 12% of controls. After controlling for lifestyle variables and other chronic diseases, CVD (especially hypertension, heart failure and cerebrovascular lesions) conferred an odds ratio for hip fracture of 2.38. The risk of hip fracture increased with number of hospitalizations for CVD, and was particularly high after a recent CVD event—odds ratio 7.61 for fracture within 180 days of hospitalization for CVD.

The mechanism by which CVD influences fracture risk remains to be determined. The authors suggest that impaired calcium metabolism or increased oxidative stress in CVD could affect bone mineral metabolism; alternatively, they suggest that side effects of medication for CVD might increase the risk of falls.