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European Heart Journal Advance Access published online on November 4, 2009
European Heart Journal, doi:10.1093/eurheartj/ehp483
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Published on behalf of the European Society of Cardiology 2009.

Hip fractures and heart failure: findings from the Cardiovascular Health Study{dagger}

Laura Carbone1,2,*, Petra Buzková3, Howard A. Fink4,5,6, Jennifer S. Lee7, Zhao Chen8, Ali Ahmed9,10, Susmita Parashar11 and John R. Robbins12

1 Department of Veterans Affairs Medical Center, Memphis, TN, USA
2 Department of Medicine, University of Tennessee Health Science Center, 956 Court Ave, Memphis, TN 38163, USA
3 Department of Biostatistics, University of Washington, Seattle, WA, USA
4 Geriatric Research Education and Clinical Center, VA Medical Center, Minneapolis, MN, USA
5 Center for Chronic Disease Outcomes Research, VA Medical Center, Minneapolis, MN, USA
6 Department of Medicine, University of Minnesota, Minneapolis, MN, USA
7 Division of Endocrinology, Clinical Nutrition, and Vascular Medicine, University of California – Davis, Sacramento, CA, USA
8 Division of Epidemiology and Biostatistics Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA
9 University of Alabama at Birmingham, Birmingham, AL, USA
10 Veterans Affairs Medical Center, Birmingham, AL, USA
11 Department of Medicine, Division of Cardiology, Emory University, Atlanta, GA, USA
12 University of California – Davis, Sacramento, CA, USA

Received 1 August 2009; revised 16 September 2009; accepted 15 October 2009 * Corresponding author. Tel: +1 901 448 5479, Fax: +1 901 448 7263, Email: lcarbone{at}utmem.edu

Aims: The aim of the study was to find the epidemiology of hip fractures in heart failure. The increasing survival rate for patients with heart failure places them at risk for other diseases of ageing, including osteoporosis.

Methods and results: We included 5613 persons from the Cardiovascular Health Study (CHS) with an average of 11.5 year follow-up. We determined incidence rates and hazard ratios (HRs) in persons with heart failure compared with persons without heart failure and mortality hazards following these fractures. Annualized incidence rates for hip fractures were 14 per 1000 person-years in heart failure and 6.8 per 1000 person-years without heart failure. Unadjusted and multivariable adjusted HRs for hip fracture associated with heart failure in men were 1.87 (95% CI 1.2–2.93) and 1.59 (95% CI 0.93–2.72), respectively. Respective HRs for women were 1.75 (95% CI 1.27–2.4) and 1.41 (95% CI 0.98–2.03). Mortality hazard was ~2-fold greater in patients with heart failure and hip fracture compared with those having heart failure alone.

Conclusion: Persons with heart failure are at high risk for hip fractures. However, much of the association between hip fractures and heart failure is explained by shared risk factors. Hip fractures are a substantial contributor to mortality in men and women with heart failure.

Key Words: Hip fractures • Heart failure • Mortality

{dagger} A full list of principal CHS investigators and institutions can be found at http://www.chs-nhlbi.org/pi.htm


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