LAUSR

Background: There is conflicting evidence regarding the association between atrial fibrillation (AF) and the risk of subsequent fractures. Methods: We included participants aged 45 years or older from the Framingham Heart Study Offspring, Third Generation, New Offspring Spouse, Omni 1, and Omni 2 cohorts. We prespecified analyzing index age 65 years as our primary analysis; we repeated analyses for index age 45, 55, and 75 years. The primary outcome was any bone fracture, except finger, toe, foot, skull, and facial fractures. We assessed the association between time-varying AF and subsequent fractures by an illness-death model that accounted for the competing risk of death. We estimated hazard ratios (HR) adjusted for age, sex, body mass index, smoking, diabetes, alcohol intake, and prior fracture. Results: We included 3,403 participants (mean age of 68 years, 53.3% female) in the analysis at index age 65 years and above. In all, 525 (15%) participants developed incident fractures during follow-up. The HR between AF and subsequent fracture was 1.36 95%CI (1.05-1.77). There was no evidence of effect modification by sex (HR 1.63, 95%CI 1.05-2.23 in men; HR 1.22, 95%CI 0.84-1.76; interaction p value 0.27). Results were consistent at other index ages. Conclusion: AF was associated with increased risk of incident fracture in the community-based Framingham Heart Study.