Does atrial fibrillation increase the risk of fractures? A systematic review and meta-analysis.

Objectives: We have observed in clinical practice that patients with fractures often have concomitant atrial fibrillation. However, it remains unclear whether atrial fibrillation increases the risk of bone fracture. A meta-analysis was performed to investigate the association between atrial fibrillation and fracture.

Methods: PubMed and Cochrane Library were searched for relevant studies from 1 January 1943 to 31 December 2024 that compared the prevalence of fracture in atrial fibrillation group with non-atrial fibrillation group.

Results: A total of five cohort studies with 187,868 participants met all the eligibility criteria for our study. A total of 835 people suffered a fracture in atrial fibrillation group and 6,512 in non-atrial fibrillation group. The overall risk of fractures was non-statistically higher in patients with 5.4% (835/15,395) in atrial fibrillation group and 3.8% (6,512/172,473) in non-atrial fibrillation group. Analysis of included studies observed non-significant association between atrial fibrillation and fractures [odds ratio (OR) = 1.17, 95% confidence interval (CI) = 0.60-2.29, = 0.65]. However, subgroup analysis displayed that Asian population with atrial fibrillation had a higher risk of fracture (OR = 1.61, 95% CI = 1.38-1.87, < 0.00001), whereas no similar outcomes were seen in Caucasian population (OR = 0.94, 95% CI = 0.24-3.59, = 0.92).

Conclusion: The evidence indicated that Asians with atrial fibrillation were more prone to fractures.

Systematic Review Registration: https://www.crd.york.ac.uk/PROSPERO/myprospero, identifier CRD42018107794.