Effect of atrial fibrillation on the incidence and outcome of osteoporotic fracture ― A nationwide population-based study ―

Daehoon Kim, Pil Sung Yang, Tae Hoon Kim, Jae Sun Uhm, Junbeom Park, Hui Nam Pak, Moon Hyoung Lee, Boyoung Joung

Research output: Contribution to journalArticlepeer-review

8 Scopus citations


Background: Both atrial fibrillation (AF) and osteoporosis are common in older adults. The purpose of this study was to investigate whether comorbid AF in patients with osteoporosis is associated with fracture incidence, or death after fracture. Methods and Results: From the National Health Insurance Service database of Korea, we selected 31,778 patients with osteoporosis. During a median follow-up of 48 months, the incidence of bone fractures was higher in AF patients than in non-AF patients (3.20 vs. 2.18 per 100 person-years), respectively. In the multivariate Cox regression analysis, AF was associated with fracture independently of other risk factors with an adjusted hazard ratio (HR) of 1.21 (95% confidence interval [CI], 1.02–1.41; P=0.031). The mortality rate after fracture was significantly higher in AF patients than it was in non-AF patients (adjusted HR, 1.92; 95% CI, 1.35–3.27; P=0.016). After propensity score-matching, AF was consistently associated with a higher risk of osteoporotic fracture and subsequent death after fracture. In AF patients, older age, female sex, being underweight (body mass index <18.5 kg/m2), decreased physical activity (exercise <3 times/week), history of stroke or transient ischemic attack, thiazide use, sedative use, and higher CHADS2 (≥2 points) or CHA2DS2-VASc (≥2 points) scores were associated with the incidence of fractures. Conclusions: Comorbid AF in patients with osteoporosis was associated with an increased risk of bone fracture and death after fracture.

Original languageEnglish
Pages (from-to)1999-2006
Number of pages8
JournalCirculation Journal
Issue number8
StatePublished - 2018

Bibliographical note

Funding Information:
This study was supported by a CMB-Yuhan research grant of Yonsei University College of Medicine (6-2015-0173), research grants from the Basic Science Research Program through the National Research Foundation of Korea funded by the Ministry of Education, Science and Technology (NRF-2012R1A2A2A02045367), and a grant from the Korean Healthcare Technology R&D project funded by the Ministry of Health & Welfare (HI16C0058, HI15C1200).

Publisher Copyright:
© 2018, Japanese Circulation Society. All rights reserved.


  • Atrial fibrillation
  • Death
  • Fractures
  • General population
  • Osteoporosis


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