Advisory Committee Chair
Nicole Wright
Document Type
Thesis
Date of Award
2024
Degree Name by School
Master of Science in Public Health (MSPH) School of Public Health
Abstract
Background: Fragility fractures pose a significant healthcare and economic burden in the United States. While age and bone mineral density (BMD) are the primary established risk factors for fragility fractures, the relationship between cardiovascular disease (CVD) and fractures remains underexplored. The primary objective of this analysis was to estimate the association of CVD risk with fractures in postmenopausal women. Methods: Utilizing 30 years of data from the WHI, Atherosclerotic Cardiovascular Disease (ASCVD) risk scores were computed using baseline age, race, systolic blood pressure, total cholesterol, high-density lipoprotein, diabetes, anti-hypertension medications, and smoking. Fracture outcomes encompassed any clinical fracture, major osteoporotic fractures (MOF), and hip. Cox proportional hazard models accounting for the WHI study component were used to assess the association between ASCVD and fracture risk, adjusting for sociodemographic, lifestyle, nutrition, and health variables. Effect modification by obesity status was explored. Results: Among the 161,808 women in the WHI, 5,519 had complete data for ASCVD score calculation. Of these, 40.3%, 15.1%, 32.5%, and 12.1% of participants fell into low, borderline, intermediate, and high CVD risk categories respectively based on ASCVD iv thresholds. Compared to those with a low ASCVD score, a high ASCVD score was associated with significant elevated fracture risk (Any clinical - HR: 1.48, 95% CI: 1.28– 1.72; MOF- HR: 2.35; 95% CI: 1.93–2.87; hip - HR: 4.97; 95% CI: 3.34–7.40). The associations attenuated after adjustment, but compared to the low ASCVD score group, significantly higher fracture risk was still observed in the fully adjusted model for MOF in the intermediate group (HR: 1.31, 95% CI: 1.07–1.60), and for MOF (HR: 1.38, 95% CI: 1.02–1.86) and hip fracture (HR: 1.88, 95% CI: 1.03–3.43) in the high ASCVD group. No evidence of heterogeneity by obesity status was observed in the association between ASCVD risk and fractures. Conclusion: In this racially and ethnically diverse sample of postmenopausal women, a higher ASCVD score was significantly associated with higher MOF and hip fracture risk. Integrating CVD risk assessment could provide valuable insights for clinical practice regarding fracture prevention strategies.
Recommended Citation
Hossain, Rafeka, "The Association Between Cardiovascular Disease Risk And Fractures In Postmenopausal Women" (2024). All ETDs from UAB. 3890.
https://digitalcommons.library.uab.edu/etd-collection/3890