Pulse Pressure Variability and the Risk of Fragility Fracture: The Kailuan Prospective Cohort Study in China

Objectives: To investigate the association of the magnitude and direction of pulse pressure variability (PPV) with the incidence of fragility fracture in the general population.Methods: This prospective cohort study included current Kailuan Group employees and retirees who attended health checkups continuously from 2006 to 2010 and were followed up until December 31, 2021. A total of 56,129 individuals who completed the health checkups were selected and grouped according to coefficient of variation (CV) quartile for PPV. The standard deviation (SD) and variability independent of the mean were also calculated as measures of PPV. The cumulative incidence of fragility fracture in the four groups was calculated and the impact of PPV on the risk of fragility fracture was analyzed using a multivariate Cox regression model. The direction of the variation was also assessed.Results: There were 671 cases of fragility fracture (1.2%) during a median follow-up of 11 years. In the multivariable-adjusted model, the hazard ratio for fragility fracture was 1.37 (95% confidence interval 1.11-1.70) for the highest CV quartile for PPV versus the lowest CV quartile for PPV. There was a linear asso-ciation between higher PPV and fragility fracture. Consistent results were noted for higher PPV and the risk of fragility fracture using other indices of variability and in various sensitivity and subgroup analyses.Conclusions: High PPV was associated with a higher rate of fragility fracture independently of blood pressure. Reduction of PPV may help to prevent fragility fractures in the general population.

Automated summary

This study investigated the association between the magnitude and direction of pulse pressure variability (PPV) and the incidence of fragility fracture in the general population. The results showed a linear relationship between higher PPV and increased risk of fragility fracture, independent of blood pressure. Therefore, reducing PPV may help prevent fragility fractures in the general population.