Association of covert brain infarcts and white matter hyperintensities with risk of hip fracture in older adults: the Cardiovascular Health Study.

Autor: Sheets KM; Department of Medicine, University of Minnesota, Minneapolis, MN, USA. kerry.sheets@hcmed.org.; Division of Geriatrics, Department of Medicine, Hennepin Healthcare, 701 Park Ave, Minneapolis, MN, 55415, USA. kerry.sheets@hcmed.org., Buzkova P; Department of Biostatistics, University of Washington, Seattle, WA, USA., Chen Z; Division of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA., Carbone LD; Charlie Norwood Veterans Affairs Center, Augusta, GA, USA.; Department of Medicine, J. Harold Harrison M.D. Distinguished Chair in Rheumatology, Medical College of Georgia, Augusta University, Augusta, GA, USA., Cauley JA; Department of Epidemiology, School of Public Health, University of Pittsburg, Pittsburg, PA, USA., Barzilay JI; Division of Endocrinology, Kaiser Permanente of Georgia, Duluth, GA, USA.; Division of Endocrinology, Emory University School of Medicine, Druid Hills, USA., Starks JL; Department of Neurology, University of Minnesota, Minneapolis, MN, USA.; Department of Neurology, VA Health Care System, Minneapolis, MN, USA., Miller LM; Division of Nephrology-Hypertension, University of California San Diego, San Diego, CA, USA., Fink HA; Department of Medicine, University of Minnesota, Minneapolis, MN, USA.; Geriatric Research Education and Clinical Center, VA Health Care System, Minneapolis, MN, USA.
Jazyk: angličtina
Zdroj: Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA [Osteoporos Int] 2023 Jan; Vol. 34 (1), pp. 91-99. Date of Electronic Publication: 2022 Nov 10.
DOI: 10.1007/s00198-022-06565-x
Abstrakt: Covert brain infarcts and white matter hyperintensities (WMHs), incidental markers of brain microvascular disease commonly seen on brain MRIs in older adults, have been associated with falls and lower bone mineral density. We found covert infarcts and WMHs may also be associated with an increased risk of future hip fracture.
Introduction: To determine whether covert infarcts and white matter hyperintensities (WMHs) are associated with increased risk of incident hip fracture.
Methods: A prospective cohort of 3373 community-dwelling adults aged ≥ 65 years enrolled in the Cardiovascular Health Study with a brain MRI (1992-1993) was analyzed. Covert infarcts were categorized by number of infarcts and largest infarct size. WMH burden was assessed by radiologists and graded qualitatively from 0 (no WMHs) to 9 (extensive).
Results: Participants had 465 incident hip fractures during a mean follow-up of 12.8 years. The demographic-adjusted hazard of incident hip fracture was 32% higher among participants with ≥ 1 covert infarct compared to those without infarcts (hazard ratio (HR) 1.32; 95% CI, 1.08-1.62). The hazard of incident hip fracture was similar after further adjustment for medications and medical history (HR = 1.34; 95% CI, 1.08-1.65), but attenuated following additional adjustment for functional status, frailty, and falls (HR = 1.25; 95% CI, 0.99-1.57). Fully adjusted hazard of incident hip fracture per increase in infarct number was 1.10 (95% CI, 0.98-1.23); risk in individuals whose largest infarct was ≥ 20 mm versus 3 to < 20 mm was similar. Compared with WMH grades 0-1, the demographic-adjusted hazard of hip fracture was 1.34 (95% CI, 1.09-1.66) and 1.83 (95% CI, 1.37-2.46), respectively, for WMH grades 2-3 and 4-9. The hazard was similar following adjustment for medications and medical history (grades 2-3: HR = 1.32; 95% CI, 1.05-1.64; grades 4-9: HR = 1.69; 95% CI, 1.23-2.30), but attenuated following additional adjustment for functional status, frailty, and falls (grades 2-3: HR = 1.24; 95% CI, 0.98-1.56; grades 4-9: HR = 1.34; 95% CI, 0.95-1.90).
Conclusion: Older, community-dwelling adults with covert infarcts or WMHs may be at increased risk of hip fracture.
(© 2022. International Osteoporosis Foundation and Bone Health and Osteoporosis Foundation.)
Databáze: MEDLINE
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