Fracture and the risk of coronary events in women with heart disease

Background Osteoporosis is associated with aortic calcification and cardiovascular mortality. However, whether skeletal fractures predict the risk of coronary events is unknown. Methods We used Cox proportional hazards models to determine whether postmenopausal fracture was associated with the risk of coronary heart disease events among the 2763 postmenopausal women with known coronary disease enrolled in the Heart and Estrogen/progestin Replacement Study. Because fractures occurred before enrollment (in 615 women) and during follow-up (in 276 women), we treated incident fracture as a time-dependent covariate in our models. Results During a mean follow-up of 4.1 years, 361 women had coronary heart disease events. The risk of these events was 25% lower in women who sustained fractures than in those without fractures (hazard ratio [HR] = 0.74; 95% confidence interval [CI]: 0.57 to 0.96; P = 0.02). This association was not confounded by physical activity or by factors associated with both fracture and coronary heart disease events (HR = 0.75; 95% CI: 0.57 to 0.98; P = 0.04). Conclusion Postmenopausal women with heart disease who had skeletal fractures had a reduced risk of subsequent coronary events. This unexpected association, if confirmed in future studies, could influence risk-related treatment strategies for cardiovascular disease.