Cardiovascular risk factors for falls and fractures in the elderly

Background: The population is getting older and low-energy falls and fractures are a growing health challenge as their incidence increase with advancing age. With the ageing population follows an alternation in phsiology and an increased number of comorbidities and medications. These comorbidities and medications may constitute an increased risk for fall and fracture. Low-energy fractures are associated with great suffering and death among the elderly, a great cost to society and a challenge to the health care systems. Aims: The overall objective was to investigate correlation between cardiovascular risk factors for low energy falls and fractures. The risk factors analyzed were comorbidities, medications and polypharmacy, orthostatic hypotension and resting heart rate and cardiovascular biomarkers. Material and methods: Study I and II are prospective case series. We analyzed the same cohort of 272 consecutive patients who underwent acute hip fracture surgery. Analysis of how comorbidities at baseline and alterations among medications might affect readmission and mortality during the 6 month follow up. Study III and IV were retrospective population-based studies. In study III we analyzed if orthostatic hypotension (OH) and resting heart rate at baseline among a cohort of 33000 patients enrolled in Malmö Preventive Project (MPP) study, might increase the incidence of first low-energy fracture during a follow up period of 25 years. In study IV we investigated whether cardiovascular biomarkers at baseline among 5291 patients in Malmö Diet and Cancer (MDC) study could increase the incidence of first low-energy fractures during the follow-up of 21 years. Results: Among hip fracture patients in Study I, hypertension and ischemic heart diseases, as well as cognitive disorders were the most common comorbidities in hip fracture patients. Hypertension and pacemaker treatment increased the risk of readmission, whereas mortality increased with ischemic heart disease and malignancy. In Study II, the total number of medication, anti-osteoporotic agents, SSRI and eyedrops were associated with higher rate of readmission, whereas vitamin K antagonist, thiazides and tramadol were associated with readmission due to a new fall. In Study III, orthostatic decline in blood pressure and elevated resting heart rate indepenently predicted increased incidence of low-energy fractures. In Study IV, higher levels of circulating levels of the cardiovascular biomarker MR-pro-ADM predict low-energy falls among middle-aged men, but not women. Conclusions: Common cardiovascular comorbidities among the ageing population increase the risk of hip fracture, readmission and mortatlity and certain medications also increase the risk of readmission. Suffering from OH and elevated resting heart rate constitute an increase risk of suffering from a low-energy fracture. In Study IV, higher levels of the cardiovascular biomarker MR-pro-ADM predicted low-energy fracture among middleaged men men, but not among women. These findings emphasize the importance of future collaboration between different specialities within hospitals and medical care to idientify high risk patients, as well as the role of medication reviews to improve risk prevention.