In Reply: I agree with Dr Strandberg that hypertension is one possible mediating link for a common predisposition to heart failure, stroke, and hip fracture. In this study as well as a previous one,1 hypertension was an independent risk factor for hip fracture. However, our estimates for heart failure, stroke, ischemic heart disease, and peripheral atherosclerosis all were adjusted for hypertension and therefore are independent of this diagnosis, although the possibility of residual confounding by hypertension not captured by our data cannot be eliminated. Also, the study results were not explained by several common treatments for hypertension. Thus, it is unlikely that hypertension alone could explain the excess risk of hip fracture associated with other cardiovascular diseases found in this study.
Michaëlsson K. Cardiovascular Disease, Hypertension, and Risk of Hip Fracture—Reply. JAMA. 2010;303(8):731-732. doi:10.1001/jama.2010.136