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

IF 4.3 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS American journal of preventive cardiology Pub Date : 2025-01-27 DOI:10.1016/j.ajpc.2025.100938

Shih-Kai Kao , Yu-Ting Yu , Ming-Hsien Tsai

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Abstract

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.

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