Benign Paroxysmal Positional Vertigo Is Associated With an Increased Risk of Fracture: A Population-Based Cohort Study

STUDY DESIGN: A nationwide, population-based, retrospective cohort study. OBJECTIVES: To investigate whether benign paroxysmal positional vertigo (BPPV) is associated with an increased risk of fracture. BACKGROUND: Benign paroxysmal positional vertigo is a brief rotational vertigo induced by head position change that may increase the risk of falls and, therefore, fracture. METHODS: Data from the Taiwan National Health Insurance Research Database were used for this study. We selected a case cohort comprising 3796 patients aged over 20 years who were-newly diagnosed with BPPV between 2000 and 2006. In addition, we randomly selected a control cohort of 15 184 individuals without BPPV. Patients with BPPV were matched to individuals in the control group according to sex, age, and index year. A Cox proportional hazard regression was performed to compute the hazard ratio of fracture, after adjusting for demographic characteristics and comorbidities. RESULTS: The prevalence of comorbidities was higher among patients with BPPV. After adjusting for age, sex, and comorbidities, patients with BPPV exhibited a 1.14-fold (95% confidence interval [CI]: 1.04, 1.25; P<.01) higher risk of fracture than those without BPPV. Trunk fracture (vertebra, rib, and pelvis) was the fracture type with the highest adjusted hazard ratio (1.24; 95% CI: 1.06, 1.45; P<.01) in patients with BPPV relative to those without BPPV. An analysis stratified according to demographic factors revealed that men with BPPV exhibited a 1.43-fold (95% CI: 1.22, 1.66; P<.001) higher risk of fracture. Patients with BPPV aged over 65 years exhibited-a significantly higher risk of fracture (adjusted hazard ratio = 1.17; 95% Cl: 1.03,1.33; P<.05) than did those without BPPV. CONCLUSION: Patients with BPPV exhibited a higher risk of fracture than did those without BPPV.