LAUSR

Background Previous studies have demonstrated that patients with peripheral arterial disease (PAD) had lower bone mineral density, particularly in the femur, compared with general population. Therefore, it is possible that patients with PAD may have a higher risk of osteoporotic hip fracture. Objectives To compare the risk of developing hip fracture between patients with PAD and individuals without PAD. Methods A systematic literature search was conducted using EMBASE and MEDLINE database from inception to November 2017 to identify all cohort studies that investigated the risk of incident hip fracture among patients with PAD compared with individuals without PAD. The systematic literature review was independently conducted by the first two investigators using the search strategy that included the terms for ‘peripheral arterial disease’ and ‘hip fracture’. Eligible studies must be cohort studies (either prospective or retrospective) that reported the risk of incident hip fracture among patients with PAD. Comparators must be individuals without PAD. Eligible studies must provide the effect estimates (relative risks (RR) or hazard ratios (HR)) with 95% confidence intervals (CI) for the calculation of pooled effect estimates. Adjusted point estimates from each study were combined togetehr using the random-effect, generic inverse variance method as described by DerSimonian and Laird. Results Of 8464 retrieved articles, 6 cohort studies (3 prospective cohort studies and 3 retrospective cohort studies) involving 15 895 patients with PAD and 2 33 835 comparators without PAD met the eligibility criteria and were included in the meta-analysis. We found a significantly increased risk of incident hip fracture among patients with PAD compared with individuals without PAD with the pooled RR of 1.64 (95% CI: 1.17 to 2.29). The statistical heterogeneity was high with an I2 of 80%. Subgroup analysis by study design showed a significantly increased risk of incident hip fracture among patients with PAD for both prospective studies (pooled RR 1.60; 95% CI: 1.12 to 2.28; I20%) and retrospective studies (pooled RR 1.72; 95% CI: 1.07 to 2.77; I292%) as shown in figure 1. Conclusions In summary, this study demonstrated a significantly increased risk of incident hip fracture among patients with PAD compared with individuals without PAD. Disclosure of Interest None declared