Abstract P1035: The Association between PREVENT 10-Year Overall Cardiovascular Disease Risk and Incident Fractures in Postmenopausal Women

Background: This study aimed to estimate the association between cardiovascular disease (CVD) risk and incident fracture in postmenopausal women. Methods: The study included data from women without a history of CVD enrolled in the Women’s Health Initiative, who had available CVD biomarker information at baseline necessary to compute a 10-year overall CVD risk using the PREVENT equation. Outcomes included self-reported any clinical, major osteoporotic (MOF-hip, spine, wrist, shoulder), and hip fractures. Women reporting anti-osteoporosis medications at baseline and pathologic fractures during follow-up were excluded. Hierarchical multivariable Cox proportional hazard models assessed the association of CVD risk with fracture and if the association was modified by race and ethnicity or body mass index (BMI). Results: Our study comprised 21,300 women (age: 63.7±7.3 years; non-Hispanic (NH) White: 48%; NH-Black: 33%). The mean 10-year overall CVD risk score was 9.3 ± 5.7, with 5,370 (25.2%), 4,169 (19.6%), 10,661 (50.0%), and 1,100 (5.2%) participants in the low (<5.0%), borderline (5.0-7.4%), intermediate (7.5-19.9%, and high ≥20.0%) categories, respectively. A total of 9,399, 5,104, and 1,769 clinical, MOF, and hip fracture cases were reported over a mean follow-up of 17.1 ± 6.7 years. After full covariate adjustment (Model 4) and adjustment for factors significantly associated with fracture from stepwise modeling (Model 5), women with intermediate- and high- overall CVD risk scores had significantly higher risk for all fracture types, particularly hip fracture [Model 5 HR (95% CI) - intermediate: 2.43 (1.53, 3.87); high: 3.56 (2.01, 6.15)] (Table). Neither race and ethnicity nor BMI modified the association between overall CVD risk and fracture. Conclusion: In postmenopausal women, higher CVD risk scores significantly associated with a higher risk of incident fractures. Future studies assessing if management of CVD aids in fracture prevention in high-risk CVD populations based on PREVENT score is warranted.