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% CI: 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. Level of evidence Prognosis, level 2b. J Orthop Sports Phys Ther 2015;45(5):406–412. Epub 26 Mar 2015. doi:10.2519/jospt.2015.5707