Frequency of hypertension in hospitalized population with osteoporotic fractures: Epidemiological retrospective analysis of Hospital Discharge Data in the Apulian database for the period 2006–2010

Abstract

Osteoporosis and hypertension are two widespread diseases, which share many of the same risk factors such as advanced age, early menopause, smoking, and physical inactivity. The aim of this study is to examine the association between fragility fractures, anti-hypertensive drugs (subgroup C02, according to the Anatomical Therapeutic Chemical classification system [ATC]), diuretics (subgroup C03), b-blocker (subgroup C07), calcium antagonist (subgroup C08) and renin-angiotensin-aldosterone system regulator (subC09), and drugs administration for osteoporosis among the osteoporotic population of a region of Southern Italy. We retrospectively studied “Hospital Discharge Data” (HDD) in the Apulian database for the period 2006–2010 to find fragility fractures treated with hospitalization in men aged over 65 years and in women aged over 50 years. We then checked the database for drug prescriptions to identify those patients who had taken at least one osteoporosis drug. Within this latter group, based on hospital admissions and prescription records, we identified the patients affected with hypertension. We observed that, between 2006 and 2010, in Apulia, 177,639 patients were hospitalized and diagnosed as having fragility fractures. The prevalence of hypertension patients in Apulia in this period was estimated at 44.3%. In the same region and period, the prevalence of patients with fragility fracture, who also had hypertension, was 80.9%. The percentage of fracture was lowest in the female population aged 50–59 years (52.5%), while the highest was in women aged > 80 years (92.5%). We observed that in hypertensive patients the most frequent site of fracture was the femur (43,638 cases), while the least frequent were the tarsus and metatarsus (742 cases combined). The patients who took angiotensin-converting enzyme (ACE) inhibitor and diuretic drugs presented a higher number of fragility fractures, while the calcium antagonists, beta-blockers, and ATC anti-hypertensive drugs were linked to a reduced incidence of lesions. Hypertension is associated with increased fracture risk in the Apulia population. The bone demineralization effect of this disease should be taken into account during the management of these patients. The different distribution of fragility fractures in relation to anti-hypertensive treatment warrants further investigation.