Risk of adverse cardiovascular events following spinal cord injury in patients with osteoporosis: Real-world evidence

Introduction: Spinal cord injury (SCI) is associated with increased cardiovascular risks, and cardiovascular disease (CVD) remains a leading cause of death for individuals with SCI. Osteoporosis, a condition associated with SCI, has been linked to CVD. However, the cardiovascular risk profile of ind...

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Bibliographic Details
Main Authors: Shih-Kai Kao, Yu-Ting Yu, Ming-Hsien Tsai
Format: Article
Language:English
Published: Elsevier 2025-03-01
Series:American Journal of Preventive Cardiology
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Online Access:http://www.sciencedirect.com/science/article/pii/S266666772500011X
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Summary:Introduction: Spinal cord injury (SCI) is associated with increased cardiovascular risks, and cardiovascular disease (CVD) remains a leading cause of death for individuals with SCI. Osteoporosis, a condition associated with SCI, has been linked to CVD. However, the cardiovascular risk profile of individuals with SCI with osteoporosis remains unclear. Methods: We conducted a retrospective cohort study by using data from the TriNetX Research Network. We included adults with osteoporosis with or without a diagnosis of SCI between 2015 and 2020: case (SCI group, N = 7,308) and control (non-SCI group, N = 843,235) cohorts. Propensity score matching was performed to balance baseline characteristics between the cohorts (N = 7,296 in each group). A Cox regression model was employed to estimate the hazard ratio (HR) for the primary outcomes: the development of acute myocardial infarction (AMI), atrial fibrillation (AF), or heart failure (HF). Results: Individuals with SCI with osteoporosis have a significantly higher risk of cardiovascular events (HR: 1.15, 95 % confidence interval [CI]: 1.08–1.22)—including AMI (HR: 1.17 95 % CI: 1.02–1.33), AF (HR: 1.14, 95 % CI: 1.04–1.24), and HF (HR: 1.14, 95 % CI: 1.05–1.24)—than do those without SCI. Furthermore, mortality risk is higher in individuals with SCI, particularly those with pathological fracture. Subgroup analyses based on sex and age supported these findings. Conclusion: The complex interplay between SCI, osteoporosis, and cardiovascular health underscores the requirement for comprehensive management strategies for individuals with SCI who also have osteoporosis.
ISSN:2666-6677