Fractures in patients with and without congenital heart disease - A nationwide register-based cohort study
Linda Ashman Kröönström1,2, Mikael Dellborg3,4, Kok Wai Giang5
1Occupational and Physical Therapy Department, Sahlgrenska University Hospital, Gothenburg, Sweden.
Insights
Older adults with congenital heart disease (CHD) face an increased fracture risk. Younger patients with complex CHD show a decreased risk, highlighting the need for age-specific fracture monitoring in aging CHD populations.
Area of Science:
- Cardiology
- Geriatrics
- Public Health
Background:
- Congenital heart disease (CHD) patients are living longer, necessitating research into age-related health issues.
- Fracture risk assessment is crucial for the aging CHD population.
Purpose of the Study:
- To determine the incidence and risk of fractures in patients with congenital heart disease.
- To compare fracture rates between individuals with and without CHD across different age groups.
Main Methods:
- Utilized data from the National Swedish Patient Register (83,084 CHD patients) and the Total Population Register (719,447 controls).
- Matched patients and controls by birth year and sex, classifying CHD by complexity and fractures by anatomical site.
Main Results:
- Younger patients (0-17 years) with complex CHD had lower fracture incidence rates than controls.
- Overall, patients with CHD had a slightly higher fracture incidence (7.42 vs. 7.06 per 10,000 person-years).
- Individuals with CHD aged 60 years and older had a 21% increased risk of fractures compared to controls.
Conclusions:
- Younger patients with complex CHD exhibit a reduced fracture risk, while older patients show an elevated risk.
- The increased fracture risk in older CHD patients, coupled with potential osteoporosis and reduced physical capacity, requires close monitoring.
- Age-specific fracture risk assessment is vital for managing the long-term health of the growing congenital heart disease population.
Background:
Patients with congenital heart disease (CHD) now live longer; thus, there is a need to assess factors related to ageing in this group. We aimed to determine the incidence and risk of fractures in patients with CHD.
Methods:
Data of patients with CHD were retrieved from the National Swedish Patient Register (n = 83,084) and matched according to birth year and sex, with nearly nine controls per patient from the Total Population Register in Sweden (n = 719,447). CHD diagnoses were classified according to complexity, and fractures according to anatomical disposition.
Results:
In comparison with controls, lower incidence rate (IRs) per 10,000 person-years were found in male patients (7.59, 95% confidence interval [CI]: 6.92-8.31 vs. 9.29, 95% CI: 9.06-9.53) and female patients (5.73, 95% CI: 5.11-6.40 vs. 6.02, 95% CI: 5.83-6.23) aged 0-17 years with complex CHD. However, the IR of fractures for all patients with CHD was slightly higher than that of controls (7.42 vs. 7.06 per 10,000 person-years). Patients with CHD from the oldest age group (≥60 years) had a 21% increased risk of fractures in comparison with controls without CHD.
Conclusion:
We found that younger patients with complex CHD had a decreased risk of fractures compared with controls without CHD. In contrast, older patients with CHD showed a slightly increased risk of fractures. The increased risk of fractures, together with previous reports of decreased physical capacity, increasing age, and the sequent onset of osteoporosis, warrants close attention in the ageing population of patients with CHD.
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