Impaired orthostatic blood pressure response and syncope confer a high risk of falls and trauma. The relationship between a history of unexplained syncope and orthostatic hypotension (OH) with subsequent fractures, however, has not been thoroughly examined. In this study, we aimed to investigate the relationship between previous hospital admissions due to unexplained syncope and OH and incident fractures in a middle-aged population. We analysed a large population-based prospective cohort of 30,399 middle-aged individuals (age, 57.5 ± 7.6; women, 60.2%). We included individuals hospitalised due to unexplained syncope or OH as the main diagnosis. Multivariable-adjusted Cox regression analysis was applied to assess the impact of unexplained syncope and OH hospitalisations on subsequent incident fractures. During a follow-up period of 17.8 + 6.5 years, 8201 (27%) subjects suffered incident fractures. The mean time from baseline and first admission for syncope (n = 493) or OH (n = 406) was 12.6 ± 4.2 years, and the mean age of the first hospitalisation was 74.6 ± 7.4 years. Individuals with incident fractures were older, more likely to be women, and had lower BMI, higher prevalence of prevalent fractures, and family history of fractures. Multivariable-adjusted Cox regression showed an increased risk of incident fractures following hospitalisations due to unexplained syncope (HR 1.20; 95% CI 1.02–1.40; p = 0.025) and OH (HR 1.42; 95% CI 1.21–1.66; p < 0.001) compared with unaffected individuals. Individuals hospitalised due to unexplained syncope and orthostatic hypotension have an increased risk of subsequent fractures. Our findings suggest that such individuals should be clinically assessed for their syncope aetiology, with preventative measures aimed at fall and fracture risk assessment and management.

中文翻译：

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因不明原因晕厥和体位性低血压住院的个体发生骨折的风险

直立性血压反应受损和晕厥会增加跌倒和创伤的风险。然而，不明原因晕厥史与体位性低血压 (OH) 与随后骨折之间的关系尚未得到彻底研究。在本研究中，我们旨在调查中年人群因不明原因晕厥和 OH 先前住院与意外骨折之间的关系。我们分析了一个包含 30,399 名中年人（年龄，57.5 ± 7.6；女性，60.2%）的大型基于人群的前瞻性队列。我们将因不明原因晕厥或 OH 住院的个体纳入作为主要诊断。应用多变量调整的 Cox 回归分析来评估不明原因晕厥和 OH 住院对随后发生骨折的影响。在 17.8 + 6.5 年的随访期内，8201 (27%) 名受试者发生意外骨折。从基线到首次因晕厥 (n = 493) 或 OH (n = 406) 入院的平均时间为 12.6 ± 4.2 岁，首次住院的平均年龄为 74.6 ± 7.4 岁。发生骨折的个体年龄较大，更可能是女性，并且 BMI 较低，普遍骨折的患病率较高，并且有骨折家族史。多变量调整的 Cox 回归显示因不明原因晕厥（HR 1.20；95% CI 1.02–1.40；p = 0.025）和 OH（HR 1.42；95% CI 1.21–1.66；p < 0.0）而住院后发生骨折的风险增加与未受影响的个体相比。因不明原因晕厥和体位性低血压住院的个体随后骨折的风险增加。