Key result
Hospitalization for unexplained syncope or orthostatic hypotension linked to up to ~42% greater fracture risk.
Why the study?
Impaired orthostatic blood pressure response and syncope confer a high risk of falls and trauma, but their relationship with subsequent fractures had not been thoroughly examined.
Does hospitalisation for unexplained syncope or orthostatic hypotension predict incident fractures in middle-aged individuals?
Cohort (n=30,399)
Does hospitalisation for unexplained syncope or orthostatic hypotension predict incident fractures in middle-aged individuals?
Effect estimate: HR 1.20 (syncope), HR 1.42 (OH) (95% CI 1.02-1.40 (syncope), 1.21-1.66 (OH))
p-value: p=0.025 (syncope), <0.001 (OH)
Hospitalisation for unexplained syncope or orthostatic hypotension is associated with a significantly increased risk of subsequent incident fractures, highlighting the need for fall and fracture risk assessment in these patients.
May support fall/fracture risk assessment after such hospitalizations in middle-aged adults; extends observational associations but leaves causality and interventions open.
BACKGROUND: Impaired orthostatic blood pressure response and syncope confer a high risk of falls and trauma. The relationship between a history of unexplained syncope and orthostatic hypotension (OH) with subsequent fractures, however, has not been thoroughly examined. In this study, we aimed to investigate the relationship between previous hospital admissions due to unexplained syncope and OH and incident fractures in a middle-aged population. METHODS: We analysed a large population-based prospective cohort of 30,399 middle-aged individuals (age, 57.5 ± 7.6; women, 60.2%). We included individuals hospitalised due to unexplained syncope or OH as the main diagnosis. Multivariable-adjusted Cox regression analysis was applied to assess the impact of unexplained syncope and OH hospitalisations on subsequent incident fractures. RESULTS: During a follow-up period of 17.8 + 6.5 years, 8201 (27%) subjects suffered incident fractures. The mean time from baseline and first admission for syncope (n = 493) or OH (n = 406) was 12.6 ± 4.2 years, and the mean age of the first hospitalisation was 74.6 ± 7.4 years. Individuals with incident fractures were older, more likely to be women, and had lower BMI, higher prevalence of prevalent fractures, and family history of fractures. Multivariable-adjusted Cox regression showed an increased risk of incident fractures following hospitalisations due to unexplained syncope (HR 1.20; 95% CI 1.02-1.40; p = 0.025) and OH (HR 1.42; 95% CI 1.21-1.66; p < 0.001) compared with unaffected individuals. CONCLUSIONS: Individuals hospitalised due to unexplained syncope and orthostatic hypotension have an increased risk of subsequent fractures. Our findings suggest that such individuals should be clinically assessed for their syncope aetiology, with preventative measures aimed at fall and fracture risk assessment and management.
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Johansson et al. (2021) conducted a cohort in Unexplained syncope and orthostatic hypotension (n=30,399). Hospitalisation due to unexplained syncope or orthostatic hypotension vs. Unaffected individuals was evaluated on Incident fractures (HR 1.20 (syncope), HR 1.42 (OH), 95% CI 1.02-1.40 (syncope), 1.21-1.66 (OH), p=0.025 (syncope), <0.001 (OH)). Hospitalisation for unexplained syncope (HR 1.20; 95% CI 1.02-1.40) or orthostatic hypotension (HR 1.42; 95% CI 1.21-1.66) significantly increased the risk of subsequent incident fractures.
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