Hospitalization with unexplained syncope and orthostatic hypotension linked to fracture risk: Study

Sweden: According to a study by Swedish researchers, people hospitalized owing to unexplained syncope and orthostatic hypotension are at an increased risk of future fractures. 

The findings published in the journal BMC Medicine on 27th August 2021, suggest that such people should be assessed clinically for their syncope etiology. Preventive measures meant for fall and fracture risk assessment and management should be undertaken. 

"Our population-based study is the first to provide effect sizes of unexplained syncope and orthostatic hypotension in terms of incident fracture risk in the population," the authors wrote. 

Impaired orthostatic blood pressure response and syncope increase the risk of falling and being injured. However, the link between a history of unexplained syncope and orthostatic hypotension (OH) and future fractures has not been fully investigated. The purpose of this study was to look at the link between past hospitalizations for unexplained syncope and OH and incident fractures in a middle-aged group.

It is a large population-based prospective cohort research that included 30,399 middle-aged people (age, 57.5 7.6; women, 60.2 percent). Individuals hospitalized with unexplained syncope or OH as the primary diagnosis were included in the study. The influence of unexplained syncope and OH hospitalizations on subsequent incidence fractures was studied using multivariable-adjusted Cox regression analysis.

Study Highlights:

o The incidence of incident fractures following hospitalizations for unexplained syncope and orthostatic hypotension was raised by 20% and 42%, respectively, in this large prospective, population-based, observational research.

o There was no significant difference in time between baseline and incidence fracture between the syncope/OH and no syncope/OH groups, showing that hospitalizations did not speed up fractures.

o There was a significant gap between baseline and OH/ syncope exposure.

o The majority of fractures in individuals with syncope or OH hospitalizations happened after hospitalization, with 332 (36.9%) of subjects having a fracture.

In conclusion, Dr. Madeleine Johansson added that this is the first community-based study to estimate effect sizes for unexplained syncope and orthostatic hypotension in terms of incidence fracture risk in the general population. These findings imply that such people should be clinically evaluated for syncope etiology, as well as prophylactic interventions aimed at fall and fracture risk evaluation and treatment.

Reference:

Johansson, M., Rogmark, C., Sutton, R. et al. Risk of incident fractures in individuals hospitalised due to unexplained syncope and orthostatic hypotension. BMC Med 19, 188 (2021). https://doi.org/10.1186/s12916-021-02065-7