Incident Hip Fractures among Community Dwelling Persons with Alzheimer’s Disease in a Finnish Nationwide Register-Based Cohort

Abstract

BackgroundPrevious cohort studies have shown that persons with Alzheimer’s disease (AD) have a higher risk of hip fractures but recent data from large representative cohorts is scarce.MethodsWe investigated the association between AD and prevalent and incident hip fractures in an exposure-matched cohort study conducted in Finland 2002–2009 (the Medication and Alzheimer’s disease in 2005 study; MEDALZ-2005). The study population included all community-dwelling persons with verified AD diagnosis in Finland on December 31, 2005 and one matched comparison person per AD case (N = 56,186, mean age 79.9 (SD 6.8) years, range 42–101 years). The diagnosis of AD was extracted from a special reimbursement register. Data on hip fractures during 2002–2009 was extracted from the Finnish National hospital discharge register. Analyses of incident hip fractures (n = 2,861) were restricted to years 2006–2009.ResultsPersons with AD were twice as likely to have previous hip fracture in 2005 (odds ratio, 95% confidence interval 2.00, 1.82–2.20) than matched aged population without AD. They were also more likely to experience incident hip fracture during the four-year follow-up (hazard ratio, 95% confidence interval 2.57, 2.32–2.84, adjusted for health status, psychotropic drug and bisphosphonate use). The AD-associated risk increase decreased linearly across age groups. Although people with AD had higher risk of hip fractures regardless of sex, the risk increase was larger in men than women.ConclusionFindings from our nationwide study are in line with previous studies showing that persons with AD, regardless of sex or age, have higher risk of hip fracture in comparison to general population. Although there was some suggestion of effect modification by age or sex, AD was consistently associated with doubling of the risk of incident hip fracture.

Antidepressant use and risk of hip fractures among community‐dwelling persons with and without Alzheimer's disease

“…The baseline risk of hip fracture also was higher among persons with AD compared with comparison persons. Previous studies have found that persons with AD have two times higher risk of hip fracture (Tolppanen et al, ), as well as the risk of falling seems to be two‐three times higher among persons with dementia (Allan et al, ).…”

Use of existing data sources in clinical epidemiology: Finnish health care registers in Alzheimer’s disease research – the Medication use among persons with Alzheimer’s disease (MEDALZ-2005) study

“…We also assessed the association between Ad and incident hip fracture 36. Although there was some evidence of effect modification by age and sex, Ad was consistently associated with a doubling of the risk of incident hip fracture.…”

Cohort study evaluating the risk of hip fracture among patients with dementia in Taiwan

“…Patients in the dementia cohort were more vulnerable to hip fracture than those in the comparison cohort. This result is consistent with a recent population‐based study in Finland (Tolppanen et al ., ). Contrary to a previous study that focused on Alzheimer‐type dementia, our study focused more on dementia patients than those with Alzheimer disease.…”

“…Contrary to a previous study that focused on Alzheimer‐type dementia, our study focused more on dementia patients than those with Alzheimer disease. Fewer case numbers were enrolled in our study cohort (3101 dementia patients in our study vs 56,180 patients with Alzheimer disease in the study by Tolppanen et al ) (Tolppanen et al ., ). To obtain an accurate dementia coding, only patients with more than five items of dementia coding were enrolled in our study.…”