Rapid resting heart rate: A simple and powerful predictor of osteoporotic fractures and mortality in older women

OBJECTIVES: To determine whether resting heart rate is associated with several types of osteoporotic fractures, mortality, and cause-specific mortality in older women. DESIGN: A prospective cohort study. SETTING: Four communities across the United States. PARTICIPANTS: We prospectively assessed resting pulse rate in 9,702 women aged 65 and older enrolled in the Study of Osteoporotic Fractures. MEASUREMENTS: Resting pulse was measured in the supine position. I-lip, humerus, pelvis, rib, ankle, and wrist fractures were identified by self-report and validated by radiographs. Incident vertebral fractures were assessed by quantitative morphometry. Cause-specific mortality was assessed from death certificates and hospital discharge summaries. RESULTS: Women with resting heart rates of greater than 80 beats per minute (bpm) (n = 1, 140 ( 12%)) had an adjusted 1.6-fold (95% confidence interval (0) = 1.2-2.0) increased risk of either a hip, pelvis, or rib fracture and a 1.9-fold (95% Cl = 1.4-2.5) increased risk of vertebral fracture. A heart rate of 80 bpm or greater was also associated with 1.4-fold (95% Cl = 1.2-1.5) increased all-cause mortality and 1.5-fold (95% Cl = 1.2-2.1) increased coronary heart disease mortality. Investigating resting heart rate as a continuous variable, we detected a general pattern of increasing risks with higher heart rate that could not be explained by age, weight, poor health, physical activity, hyperthyroidism, or smoking. CONCLUSIONS: Older women with resting heart rates of 80 bpm or more have an increased risk of several osteoporotic fractures and of mortality that is not explained by other risk factors. Heart rate may be a simple tool for assessing risk of fracture and of death from coronary heart disease in older women.