Hip fractures in patients with primary aldosteronism - A Swedish nationwide study

Eleftheria Gkaniatsa; Sandstrom Tatiana Zverkova; Annika Rosengren; Penelope Trimpou; Andreas Muth; Gudmundur Johannsson; Oskar Ragnarsson

doi:10.1530/endoabs.99.OC3.5

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Endocrine Abstracts (2024) 99 OC3.5 | DOI: 10.1530/endoabs.99.OC3.5

ECE2024 Oral Communications Oral Communications 3: Adrenal and Cardiovascular Endocrinology | Part I (6 abstracts)

Hip fractures in patients with primary aldosteronism – A Swedish nationwide study

Eleftheria Gkaniatsa ^1,2 , Tatiana Zverkova Sandström ³ , Annika Rosengren ^4,5 , Penelope Trimpou ^1,2 , Andreas Muth ⁶ , Gudmundur Johannsson ^1,2 & Oskar Ragnarsson ^1,2,7

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¹Institute of Medicine, Sahlgrenska Academy, Department of Internal Medicine & Clinical Nutrition, Gothenburg, Sweden; ²Sahlgrenska University Hospital, Department of Endocrinology, Gothenburg, Sweden; ³Sahlgrenska Academy, University of Gothenburg, Health Metrics Unit, Gothenburg, Sweden; ⁴Institute of Medicine, Sahlgrenska Academy, Department of Molecular and Clinical Medicine, Gothenburg, Sweden; ⁵Sahlgrenska University Hospital, Department of Medicine, Geriatrics and Emergency Medicine, Gothenburg, Sweden; ⁶Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Department of Surgery, Sweden; ⁷Wallenberg Centre for Molecular and Translational Medicine, University of Gothenburg

Objectives: Clinical studies indicate that primary aldosteronism (PA) is associated with dysregulated bone homeostasis. The aim of this study was to evaluate the incidence of hip fractures in patients with PA.

Methods: We studied a nationwide cohort of 2419 patients with PA (1997-2019) and 24 187 age and sex matched controls from the general population. Hip fractures were identified by ICD codes in the Swedish National Patient Register. We estimated hazard ratios (HRs) for incident hip fractures, adjusted for socioeconomic factors, diabetes, cardiovascular disease (CVD), osteoporosis, hyperparathyroidism, and prior fractures. Pairwise subgroup comparisons were performed by age (18-56 and ≥56 years), sex, CVD at baseline, and treatment for PA.

Results: During a mean follow up of 8±5 years, 64 (2.6%) patients had a hip fracture after being diagnosed with PA, compared to 401 (1.7%) controls. After adjustments, PA was associated with increased risk of hip fracture compared to controls (HR 1.55 [1.18-2.03]). HRs were increased in women (HR 1.76 [95% CI 1.24-2.52]), patients aged >56 years (HR 1.62 [95% CI 1.21-2.17]), and patients with CVD at diagnosis (HR 2.15 [95% CI 1.37-3.37]). PA patients treated with adrenalectomy did not have higher risk than controls (HR 0.84 [95% CI 0.35-2.0]), while patients treated with mineralocorticoid receptor antagonists (MRA) retained a greater risk (HR 1.84 [95% CI 1.20-2.83]).

Conclusions: PA is associated with increased hip fracture risk, especially in women, patients diagnosed after the age of 56 years and patients with established CVD at diagnosis. Also, patients treated with MRA seem to have an increased risk of hip fractures, while adrenalectomy may be protective.