Fracture risks in patients with arginine vasopressin deficiency: a nationwide matched cohort study

초록

Arginine vasopressin deficiency (AVP-D) might increase fracture risk. This nationwide cohort study found a significantly increased hip fracture risk in female AVP-D patients >= 50 years, but not in males. These findings highlight sex-specific vulnerability, urging focused fracture prevention in female AVP-D patients.PurposeArginine vasopressin deficiency (AVP-D) is associated with various complications and increased mortality. However, its association with long-term fracture risk remains unclear. We aimed to assess fracture risks in patients aged 50 years or older with AVP-D.MethodsWe used data from the Korea National Health Insurance Service database (2003-2020). A total of 3,497 patients aged >= 50 years diagnosed with AVP-D (2,111 men and 1,386 women) were included, along with 1:1 matched controls, based on age, sex, index year, and key comorbidities, including diabetes mellitus, hypertension, cardiovascular disease, and cerebrovascular disease. Cox proportional hazards models were used to estimate hazard ratios (HRs) with 95% confidence intervals (CIs) for the risk of major osteoporotic fractures (MOFs), vertebral fractures (VFs), non-vertebral fractures (non-VFs), and hip fractures (HFs).ResultsAfter adjusting for confounding factors, including income status, steroid use, and prior fracture history, the risk for MOFs, VFs, non-VFs, and HFs in male patients with AVP-D were comparable to those in controls. In women with AVP-D, the risk of MOFs, VFs, or non-VFs was not different from controls, but the risk of HFs was significantly higher (HR 1.83; 95% CI, 1.06-3.17). Age, female, previous history of fracture, and steroid use contributed to high risk for fracture in patients with AVP-D.ConclusionCompared with controls, only female patients with AVP-D demonstrated a significantly increased risk of HFs. These findings highlight the need for long-term follow-up, targeted screening, and proactive management of HF risk in female patients with AVP-D.

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