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Patients’ risk of bone fractures following myocardial infarction is increasing

Reuters Health • The Doctor's Channel Daily Newscast

NEW YORK (Reuters Health) – Over the past nearly 30 years, survivors of myocardial infarction have suffered an increasing rate of osteoporotic fractures, a new population-based cohort study found.

The upward trend may be a consequence of the changing landscape of MI survival: Better treatments have increased the number of MI survivors, including women and elderly who are more likely to suffer osteoporosis and bone frailty, according to research published online June 27 in the journal Circulation.

“Doctors should be attuned to the large and increasing risk of fractures among patients with MI. No specific screening test is needed other than good clinical skills,” Dr. Veronique Roger, who led the study at the Mayo Clinic in Rochester, Minn., told Reuters Health by email.

Dr. Roger’s team examined medical records from 3321 first-time MI patients and an equal number of age- and sex-matched controls in Olmsted County, Minn. from 1979 to 2006, following each for a mean of four years.

In that time, 561 people had osteoporotic fractures and 1650 died. In the MI group, there was a rate of 24.1 fractures per 1000 person-years, compared to 20.9 in the control group, and 90.3 deaths in the MI group compared to 39.8 among the controls.

Over time, however, the rate of fractures remained stable among the controls but increased in the MI group. From 1979 to 1911357, the rate in the MI group was 16.3 per 1000 person-years; from 1990 to 1911265, it was 22.5; and from 2000 to 2006, it was 34 (P for trend < 0.001). The researchers noted the association in both vertebral and nonvertebral fractures, but it was absent in non-osteoporotic fractures.

Among MI patients, the 30-day mortality risk dropped during the study period from 12.5% in the 1979 to 1989 period to 6.7% in the 2000 to 2006 period (P for trend < 0.001). Women and patients older than 75 saw the biggest declines.

In spite of the 30-day declines, the overall, longer-term mortality rate among MI patients remained constant.

“Identifying frailty among post-MI patients should prompt interventions destined to restore muscle mass and equilibrium in addition to promoting cardiovascular health. This can all be achieved through the existing cardiovascular rehabilitation programs,” Dr. Roger says.