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Cardiometabolic Multimorbidity Increases the Risk of Hip Fracture: A Longitudinal Cohort Study Based on CHARLS
Peng Tian1, Shaoxiong Du2, Run Tian1
1Department of Bone and Joint Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China.
Insights
Cardiometabolic Multimorbidity (CMM) significantly increases hip fracture risk in Chinese adults. This risk is higher in younger individuals and those with a history of falls, highlighting specific populations for targeted prevention strategies.
Area of Science:
- Gerontology
- Epidemiology
- Cardiology
Background:
- Cardiometabolic Multimorbidity (CMM) involves co-occurring heart disease, diabetes mellitus, stroke, and hypertension.
- Previous research links cardiometabolic diseases to fragility fractures, but CMM's specific impact on hip fractures in China is understudied.
- Understanding this association is crucial for developing effective fracture prevention strategies in the Chinese population.
Purpose of the Study:
- To investigate the association between Cardiometabolic Multimorbidity (CMM) and the risk of hip fracture.
- To analyze this relationship within a large Chinese cohort using prospective data.
- To identify potential effect modifiers influencing the CMM-hip fracture link.
Main Methods:
- Prospective cohort study utilizing data from the China Health and Retirement Longitudinal Study (CHARLS) from 2011 to 2020.
- Inclusion of participants aged 45 and older, with sequential exclusion of individuals with specific pre-existing conditions or data limitations.
- Analysis employed Kaplan-Meier survival analysis and multivariable Cox proportional hazards regression, including subgroup and sensitivity analyses.
Main Results:
- A cohort of 6314 participants (544 with CMM) was followed for 9 years, identifying 287 incident hip fractures.
- Participants with CMM exhibited a significantly higher incidence of hip fracture (13% vs. 8%, p=0.015).
- After adjusting for confounders, CMM was associated with a 70% increased risk of hip fracture (HR=1.70, p=0.005), with age and fall history as significant effect modifiers.
Conclusions:
- Cardiometabolic Multimorbidity (CMM) is a significant risk factor for hip fracture in the Chinese population.
- The association between CMM and hip fracture risk is particularly pronounced in individuals under 60 years old and those with a history of falls.
- These findings underscore the importance of considering CMM in hip fracture risk assessment and prevention, especially in vulnerable subgroups.
Background:
Cardiometabolic Multimorbidity (CMM) is defined as the co-occurrence of two or more conditions among heart disease, diabetes mellitus, stroke, and hypertension. Previous studies have shown associations between cardiometabolic diseases and fragility fractures; however, the relationship between CMM and hip fractures remains unclear in the Chinese population. This study therefore aims to investigate this association in a Chinese cohort to inform fracture prevention strategies.
Methods:
This prospective cohort study used data from the China Health and Retirement Longitudinal Study (CHARLS) collected from 2011 to 2020. Participants from the 2011 baseline survey cohort were initially included. Subsequently, individuals were sequentially excluded if they were under 45 years of age, had incomplete baseline CMM information, had a history of hip fracture, lost to follow-up, or had missing data on confounders. Kaplan-Meier survival analysis, Cox proportional hazards regression, subgroup analyses, and sensitivity analyses were performed to evaluate the association between CMM and the risk of hip fracture.
Results:
A total of 6314 participants aged 45 years and older were included, of whom 544 had CMM. Over a 9-year follow-up period, 287 incident hip fractures (4.55%) were identified. Among these, 36 participants had been diagnosed with CMM at baseline, whereas 251 had not. The incidence of hip fracture was significantly higher in participants with CMM than in those without CMM (13% vs. 8%, p = 0.015). After full adjustment for confounders, multivariable Cox regression showed that CMM was associated with a 70% increased risk of hip fracture (HR = 1.70, 95% CI: 1.318-2.47; p = 0.005). Subgroup analyses indicated that age and history of falls were significant effect modifiers. The association between CMM and hip fracture was more pronounced in participants under 60 years old (P for interaction = 0.048) and those with a history of falls (P for interaction = 0.014).
Conclusion:
These findings suggest that CMM increases the risk of hip fracture, particularly among relatively younger individuals and those with a history of falls.
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