Increased fracture risk associated with iron-deficiency anemia: a population-based propensity score matched cohort study.

UNLABELLED: Anemia seems to be associated with an increased risk of fracture. This cohort study of the UK primary care data shows in 84,932 anemic patients and 158,731 controls an increased fracture risk in anemic patients, also including patients < 50 years of age. Severe anemia was associated with 2 × vertebral fracture risk. Awareness of this clinically relevant association should increase.

PURPOSE: In this study, we evaluated the risk of fracture among adult patients with anemia, compared to propensity score matched controls, stratifying by fracture site, age, and severity of anemia.

METHODS

We conducted a cohort study using the UK IQVIA Medical Research Database (IMRD), incorporating The Health Improvement Network (THIN), a Cegedim database. Adults with a diagnosis of anemia and an eligible hemoglobin value (< 13 g/dL (men) or < 12 g/dL (women)) were matched to controls using propensity score matching. Cox proportional hazard models estimated the hazard ratios (HRs) for the risk of any fracture (stratified by fracture site, sex, and age (defined < 50 years and >  = 50 years)).

RESULTS

84,932 anemic patients were matched to 158,731 controls. Overall, anemia was associated with a significant 20% risk of any fracture (driven by a 32% (HR 1.32, 1.20-1.47) increase among males, no difference among females). When stratified by sex, males had a significant risk at all fracture sites (27% (HR 1.27, 1.03-1.58) risk for vertebral, 89% (HR 1.89, 1.52-2.34) risk for humerus fractures). In females, only hip (HR 1.14, 1.05-1.25) and vertebral fractures (HR 1.24, 1.07-1.43) were significantly associated with anemia. Patients ≥ 50 years had elevated risks for all sites. In patients < 50 years, only hip fracture was elevated (HR 1.86, 1.04-3.33).

CONCLUSION

Anemia was associated with a significant 20% increase of any fracture; however, this was driven by the elevated risk among males and those over the age of 50 years. Among females, only hip and vertebral fracture risk was elevated, while males had an elevated risk at all sites.