Issue: December 2016
November 21, 2016
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Fracture risk increases in primary aldosteronism

Issue: December 2016
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The risk for osteoporotic fracture and bone fracture at any site may be higher among adults with primary aldosteronism and aldosterone-producing adenoma compared with adults with essential hypertension, study data show.

Perspective from

Likwang Chen, PhD, associate investigator at the Institute of Population Health Sciences, National Health Research Institutes in Taiwan, and colleagues evaluated data from the Taiwan National Health Insurance database on 2,533 adults with primary aldosteronism, including 921 adults with aldosterone-producing adenoma diagnosed between 1997 and 2010 to determine the long-term effect of hyperaldosterone on fracture risk and possible risk mitigation by therapies. Participants were matched to adults with essential hypertension for comparison: 10,132 for primary aldosteronism and 3,684 for aldosterone-producing adenoma. Follow-up was a mean 5.3 years.

Compared with the essential hypertension group, the primary aldosteronism group had a greater risk for osteoporotic fracture (P < .001) and higher rate of bone fracture at any site (P < .001). The aldosterone-producing adenoma group also had a higher risk for bone fracture at any site compared with the essential hypertension group (P < .001).

The incident rate of bone fracture at any site was higher among the primary aldosteronism group (14.4 per 1,000 person-years) compared with the essential hypertension group (8.3 per 1,000) and the aldosterone-producing adenoma group (11.2 per 1,000) compared with the essential hypertension group (6.5 per 1,000).

The primary aldosteronism group had a higher excessive risk for fracture at any site compared with the essential hypertension group (P < .001); the same was true for the aldosterone-producing adenoma group vs. essential hypertension group (P < .001).

The risk for osteoporotic fracture may also be higher among women with primary aldosteronism (P = .008) and women with aldosterone-producing adenoma (P = .049) treated with mineralocorticoid receptor antagonists (MRA).

“[Primary aldosteronism] and hyperaldosterone were tightly associated with higher risk of bone fracture, even in the case where the competing risk of death was controlled,” the researchers wrote. “Particularly, MRA treatment might not effectively reduce osteoporotic fracture and fracture at any site among female [primary aldosteronism] patients, regardless of whether they were general [primary aldosteronism] or [aldosterone-producing adenoma] patients. It calls for more research and effort to advance early diagnosis and effective treatment in [primary aldosteronism] patients who suffer significantly higher risks from bone fracture and death.” – by Amber Cox

Disclosure: Chen is employed by Taiwan’s National Health Research Institutes, which financially supported the study.