The cardiovascular disease burden of non-traumatic fractures for adults with and without cerebral palsy

Whitney, Daniel G.<sup>1,2</sup>; Bell, Sarah<sup>1</sup>; Etter, Jonathan P.<sup>1</sup>; Prisby, Rhonda D.<sup>3</sup>

Affiliations

¹Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, USA

²Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA

³Department of Kinesiology, University of Texas at Arlington, Arlington, TX, USA

Abstract and keywords

Background: Individuals with cerebral palsy (CP) are vulnerable to non-trauma fracture (NTFx) and have an elevated burden of cardiovascular disease (CVD) related morbidity and mortality. However, very little is known about the contribution of NTFx to CVD risk among adults with CP. The purpose of this study was to determine if NTFx is a risk factor for CVD among adults with CP and if NTFx exacerbates CVD risk compared to adults without CP.

Methods: Data from 2011 to 2016 Optum Clinformatics® Data Mart and a random 20% sample Medicare fee-for-service were used for this retrospective cohort study. Diagnosis codes were used to identify adults (18+ years) with and without CP, NTFx, incident CVD up to 2 years (i.e., ischemic heart disease, heart failure, cerebrovascular disease), and pre-NTFx comorbidities. Crude incidence rates per 100 person years of CVD measures were estimated. Cox regression estimated hazard ratios (HR and 95% confidence interval [CI]) for CVD measures, comparing: (1) CP and NTFx (CP + NTFx; n = 1012); (2) CP without NTFx (CP w/o NTFx; n = 8345); (3) without CP and with NTFx (w/o CP + NTFx; n = 257,355); and (4) without CP and without NTFx (w/o CP w/o NTFx; n = 4.8 M) after adjusting for demographics and pre-NTFx comorbidities.

Results: The crude incidence rate was elevated for CP + NTFx vs. CP w/o NTFx and w/o CP + NTFx for any CVD and for each CVD subtype. After adjustments, the HR was elevated for CP + NTFx vs. CP w/o NTFx for any CVD (HR = 1.16; 95%CI = 0.98–1.38), heart failure (HR = 1.31; 95%CI = 1.01–1.70), and cerebrovascular disease (HR = 1.23; 95%CI = 0.98–1.55); although, only heart failure was statistically significant. The adjusted HR was elevated for CP + NTFx vs. w/o CP + NTFx for any CVD and for each CVD subtype (all P < .05). Stratified analyses showed a higher CVD risk by NTFx location, <65 year olds, and men when comparing CP + NTFx vs. CP w/o NTFx and w/o CP + NTFx.

Conclusions: NTFx increases 2-year CVD risk among adults with CP and compared to adults without CP. Findings suggest that NTFx is a risk factor for CVD among adults with CP.

Keywords: Cerebral palsy; Fracture; Cardiovascular disease; Ischemic heart disease; Heart failure; Cerebrovascular disease

Links

DOI: 10.1016/j.bone.2020.115376

PubMed: 32335375

WoS: 000535131500028

History

Received: 2020-03-13

Revised: 2020-04-20

Accepted: 2020-04-20

Online: 2020-04-23

Cited Works (1)

Year	Entry
2009	Bliuc D, Nguyen ND, Milch VE, Nguyen TV, Eisman JA, Center JR. Mortality risk associated with low-trauma osteoporotic fracture and subsequent fracture in men and women. JAMA. February 4, 2009;301(5):513-521.

Cited By (6)

Year	Entry
2021	Whitney DG, Devlin MJ, Alford AI, Caird MS. Pattern of bone marrow lipid composition measures along the vertebral column: a descriptive study of adolescents with idiopathic scoliosis. Bone. January 2021;142:115702.
2021	Whitney DG, Kalia V, Rajapakse CS, Fedak Romanowski EM, Caird MS, Hurvitz EA, Jepsen KJ. The effect of age when initiating anti-seizure medication therapy on fragility fracture risk for children with epilepsy. Bone. August 2021;149:115996.
2021	Whitney DG. Osteoporosis medication is associated with mortality risk reduction among adults with epilepsy: an observational study. Bone. September 2021;150:116003.
2021	Whitney DG, Hurvitz EA, Caird MS. Critical periods of bone health across the lifespan for individuals with cerebral palsy: informing clinical guidelines for fracture prevention and monitoring. Bone. September 2021;150:116009.
2022	Whitney DG, Xu T, Berri M. Post-fracture pneumonia risk and association with health and survival outcomes for adults with cerebral palsy: a retrospective cohort study. Bone. June 2022;159:116390.
2023	Whitney DG, Caird MS, Raggio CL, Hurvitz EA, Clines GA, Jepsen KJ. Perspective: a multi-trait integrative approach to understanding the structural basis of bone fragility for pediatric conditions associated with abnormal bone development. Bone. October 2023;175:116855.