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Fracture as an independent risk factor of dementia: a nationwide population-based cohort study
Chun-Hao Tsai1, Chieh-Sen Chuang, Chih-Hung Hung
1From the Graduate Institute of Clinical Medicine (C-HT, H-CH); Department of Orthopedics, China Medical University Hospital, Taichung (C-HT, C-HH, C-HT, H-CH); Graduate Institute of Clinical Medicine, College of Medicine, China Medical University, Taichung, Taiwan (C-HT, C-HT, H-CH); Department of Orthopedics, China Medical University Hospital, Taichung, Taiwan (C-HT,C-HH, H-CH); Department of Neurology, Changhua Christian Hospital, Changhua (C-SC); Department of Life Sciences, National Chung-Hsing University (C-SC); Management Office for Health Data, China Medical University Hospital (C-LL); Department of Public Health, China Medical University (C-LL, F-CS); Department of Pharmacology, School of Medicine (C-HT); Department of Medical Research, China Medical University Hospital (C-JC); and Department of Health Risk Management, China Medical University, Taichung, Taiwan (C-JC).
Abstract:
Dementia is among various diseases affecting the elderly, who is also at a high risk for fractures. This study aimed to evaluate the association between fracture history and sequential risk of dementia in Taiwan.A retrospective cohort study was designed using the claims data of the entire insured residents covered by Taiwan's universal health insurance from 1998 to 2010. A total of 66,797 patients with fractures and 133,594 control subjects without fractures were matched in terms of age (±5 years), sex, and index year and then recruited. Fractures and dementia were defined in accordance with the International Classification of Diseases, 9th Revision, Clinical Modification. The influence of fractures on the risk of dementia was analyzed using a Cox proportional hazards model.After a 12-year follow-up period, 2775 and 3991 incident cases of dementia were reported in exposed and unexposed cohorts, respectively. The overall incidence rate of dementia in individuals with fractures was 41% higher than that in individuals without fractures (6.05 vs 4.30 per 1000 person-years) at an adjusted hazard ratio of 1.38 (95% confidence interval 1.32-1.45) after age, sex, urbanization, and individual disorders or comorbidities were adjusted. Considering fracture location, we found that patients with hip fractures were at a slightly high risk for dementia. The occurrence of multiple fractures at a single visit was also significantly associated with an increased risk of dementia.Fracture history is regarded as an independent risk factor of dementia in individuals aged ≥65 years, particularly those who suffered from multiple fractures and/or fractures located in the hip. Further studies are needed to support an independent role of fracture in dementia considering the clinical information and other comorbidities.
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