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Comparison of predictors of hip fracture and mortality after hip fracture in community-dwellers with and without Alzheimer’s disease – exposure-matched cohort study
BACKGROUND: Dementia, with Alzheimer’s disease (AD) being the most common form, is a major hip fracture risk factor, but currently it is not known whether the same factors predict hip fracture among persons with and without dementia/AD. We compared the predictors of hip fracture and mortality after...
Autores principales: | , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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BioMed Central
2016
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5134120/ https://www.ncbi.nlm.nih.gov/pubmed/27908278 http://dx.doi.org/10.1186/s12877-016-0383-2 |
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author | Tolppanen, Anna-Maija Taipale, Heidi Tanskanen, Antti Tiihonen, Jari Hartikainen, Sirpa |
author_facet | Tolppanen, Anna-Maija Taipale, Heidi Tanskanen, Antti Tiihonen, Jari Hartikainen, Sirpa |
author_sort | Tolppanen, Anna-Maija |
collection | PubMed |
description | BACKGROUND: Dementia, with Alzheimer’s disease (AD) being the most common form, is a major hip fracture risk factor, but currently it is not known whether the same factors predict hip fracture among persons with and without dementia/AD. We compared the predictors of hip fracture and mortality after hip fracture in persons with and without AD. METHODS: An exposure-matched cohort of all community-dwellers of Finland who received a new clinically verified AD diagnosis in 2005–2011 and had no history of previous hip fracture (N = 67,072) and an age, sex, and region-matched cohort of persons without AD (N = 67,072). Associations between sociodemographic characteristics, comorbidities and medications and risk of hip fracture and mortality after hip fracture were assessed with Cox regression. RESULTS: As expected, the incidence of hip fractures in 2005–2012 (2.19/100 person-years vs 0.90/100 person-years in the non-AD cohort), as well as mortality after hip fracture (29/100 person-years vs 23/100 person-years in the non-AD cohort) were higher in the AD cohort. This difference was evident regardless of the risk factors. Mental and behavioural disorders (adjusted hazard ratio; HR 95% confidence interval CI: 1.16, 1.09-1.24 and 1.71, 1.52-1.92 in the AD and non-AD-cohorts), antipsychotics (1.12, 1.04-1.20 and 1.56, 1.38-1.76 for AD and non-AD-cohorts) and antidepressants (1.06, 1.00-1.12 and 1.34 1.22-1.47 for AD and non-AD-cohorts) were related to higher, and estrogen/combination hormone therapy (0.87, 0.77-0.9 and 0.79, 0.64-0.98 for AD and non-AD-cohorts) to lower hip fracture risk in both cohorts. Stroke (1.42, 1.26-1.62), diabetes (1.13, 0.99-1.28), active cancer treatment (1.67, 1.22-2.30), proton pump inhibitors (1.14, 1.05-1.25), antiepileptics (1.27, 1.11-1.46) and opioids (1.10, 1.01-1.19) were associated with higher hip fracture risk in the non-AD cohort. Similarly, the associations between mortality risk factors (age, sex, several comorbidities and medications) were stronger in the non-AD cohort. CONCLUSIONS: AD itself appears to be such a significant risk factor for hip fracture, and mortality after hip fracture, that it overrules or diminishes the effect of other risk factors. Thus, it is important to develop and implement preventive interventions that are suitable and effective in this population. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s12877-016-0383-2) contains supplementary material, which is available to authorized users. |
format | Online Article Text |
id | pubmed-5134120 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2016 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-51341202016-12-15 Comparison of predictors of hip fracture and mortality after hip fracture in community-dwellers with and without Alzheimer’s disease – exposure-matched cohort study Tolppanen, Anna-Maija Taipale, Heidi Tanskanen, Antti Tiihonen, Jari Hartikainen, Sirpa BMC Geriatr Research Article BACKGROUND: Dementia, with Alzheimer’s disease (AD) being the most common form, is a major hip fracture risk factor, but currently it is not known whether the same factors predict hip fracture among persons with and without dementia/AD. We compared the predictors of hip fracture and mortality after hip fracture in persons with and without AD. METHODS: An exposure-matched cohort of all community-dwellers of Finland who received a new clinically verified AD diagnosis in 2005–2011 and had no history of previous hip fracture (N = 67,072) and an age, sex, and region-matched cohort of persons without AD (N = 67,072). Associations between sociodemographic characteristics, comorbidities and medications and risk of hip fracture and mortality after hip fracture were assessed with Cox regression. RESULTS: As expected, the incidence of hip fractures in 2005–2012 (2.19/100 person-years vs 0.90/100 person-years in the non-AD cohort), as well as mortality after hip fracture (29/100 person-years vs 23/100 person-years in the non-AD cohort) were higher in the AD cohort. This difference was evident regardless of the risk factors. Mental and behavioural disorders (adjusted hazard ratio; HR 95% confidence interval CI: 1.16, 1.09-1.24 and 1.71, 1.52-1.92 in the AD and non-AD-cohorts), antipsychotics (1.12, 1.04-1.20 and 1.56, 1.38-1.76 for AD and non-AD-cohorts) and antidepressants (1.06, 1.00-1.12 and 1.34 1.22-1.47 for AD and non-AD-cohorts) were related to higher, and estrogen/combination hormone therapy (0.87, 0.77-0.9 and 0.79, 0.64-0.98 for AD and non-AD-cohorts) to lower hip fracture risk in both cohorts. Stroke (1.42, 1.26-1.62), diabetes (1.13, 0.99-1.28), active cancer treatment (1.67, 1.22-2.30), proton pump inhibitors (1.14, 1.05-1.25), antiepileptics (1.27, 1.11-1.46) and opioids (1.10, 1.01-1.19) were associated with higher hip fracture risk in the non-AD cohort. Similarly, the associations between mortality risk factors (age, sex, several comorbidities and medications) were stronger in the non-AD cohort. CONCLUSIONS: AD itself appears to be such a significant risk factor for hip fracture, and mortality after hip fracture, that it overrules or diminishes the effect of other risk factors. Thus, it is important to develop and implement preventive interventions that are suitable and effective in this population. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s12877-016-0383-2) contains supplementary material, which is available to authorized users. BioMed Central 2016-12-01 /pmc/articles/PMC5134120/ /pubmed/27908278 http://dx.doi.org/10.1186/s12877-016-0383-2 Text en © The Author(s). 2016 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. |
spellingShingle | Research Article Tolppanen, Anna-Maija Taipale, Heidi Tanskanen, Antti Tiihonen, Jari Hartikainen, Sirpa Comparison of predictors of hip fracture and mortality after hip fracture in community-dwellers with and without Alzheimer’s disease – exposure-matched cohort study |
title | Comparison of predictors of hip fracture and mortality after hip fracture in community-dwellers with and without Alzheimer’s disease – exposure-matched cohort study |
title_full | Comparison of predictors of hip fracture and mortality after hip fracture in community-dwellers with and without Alzheimer’s disease – exposure-matched cohort study |
title_fullStr | Comparison of predictors of hip fracture and mortality after hip fracture in community-dwellers with and without Alzheimer’s disease – exposure-matched cohort study |
title_full_unstemmed | Comparison of predictors of hip fracture and mortality after hip fracture in community-dwellers with and without Alzheimer’s disease – exposure-matched cohort study |
title_short | Comparison of predictors of hip fracture and mortality after hip fracture in community-dwellers with and without Alzheimer’s disease – exposure-matched cohort study |
title_sort | comparison of predictors of hip fracture and mortality after hip fracture in community-dwellers with and without alzheimer’s disease – exposure-matched cohort study |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5134120/ https://www.ncbi.nlm.nih.gov/pubmed/27908278 http://dx.doi.org/10.1186/s12877-016-0383-2 |
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