Fractures in patients with and without congenital heart disease – A nationwide register-based cohort study

Abstract

Background: Patients with congenital heart disease (CHD) now live longer; thus, there is a need to assess factors related to ageing in this group. We aimed to determine the incidence and risk of fractures in patients with CHD. Methods: Data of patients with CHD were retrieved from the National Swedish Patient Register (n = 83,084) and matched according to birth year and sex, with nearly nine controls per patient from the Total Population Register in Sweden (n = 719,447). CHD diagnoses were classified according to complexity, and fractures according to anatomical disposition. Results: In comparison with controls, lower incidence rate (IRs) per 10,000 person-years were found in male patients (7.59, 95% confidence interval [CI]: 6.92–8.31 vs. 9.29, 95% CI: 9.06–9.53) and female patients (5.73, 95% CI: 5.11–6.40 vs. 6.02, 95% CI: 5.83–6.23) aged 0–17 years with complex CHD. However, the IR of fractures for all patients with CHD was slightly higher than that of controls (7.42 vs. 7.06 per 10,000 person-years). Patients with CHD from the oldest age group (≥60 years) had a 21% increased risk of fractures in comparison with controls without CHD. Conclusion: We found that younger patients with complex CHD had a decreased risk of fractures compared with controls without CHD. In contrast, older patients with CHD showed a slightly increased risk of fractures. The increased risk of fractures, together with previous reports of decreased physical capacity, increasing age, and the sequent onset of osteoporosis, warrants close attention in the ageing population of patients with CHD.

Keywords

• Fractures
• Congenital heart disease
• Adult congenital heart disease
• Osteoporosis
• Physical activity
• Exercise