Albuminuria is associated with hip fracture risk in older adults: the cardiovascular health study
The microcirculation plays an important role in bone health. Here, we examine whether albuminuria, a marker of renal microvascular disease, is associated with the risk of hip fracture in older adults (age, 78 years). We find a small independent association in women but not in men.
The microvascular circulation plays an important role in bone physiology. Two studies of middle-aged adults have found that albuminuria (>30 mg albumin/g creatinine), a disorder of the renal microvasculature, is associated with fracture risk. Here, we examine whether albuminuria is related to hip fracture risk and reduced hip bone mineral density (BMD) in older adults with a mean age of 78 years.
From the Cardiovascular Health Study (41 % male), 3,110 adults with albuminuria testing were followed up for incident hip fracture for up to 9.5 years. BMD was performed in a subset of 1,208 participants.
There were 313 hip fractures during follow-up (7.7 % of men; 11.7 % of women). The incidence rate for men, with and without albuminuria, was 1.43 and 0.93/100 person-years of follow-up (p = 0.02); for women, 1.84 and 1.33 (p = 0.04). After adjustment for osteoporosis-related factors, frailty and falling, a doubling of albuminuria was significantly associated with hip fracture risk in women (hazard ratio, 1.12, 95 % CI, 1.001–1.25), but not in men. In the subcohort with BMD measurement, increased urine albumin levels were significantly associated with decreased total hip BMD in men (−0.009 g calcium/cm2 (−0.017, −0.001); p = 0.04), but not in women.
In older women, albuminuria is associated with a small, but statistically significant, increased risk of hip fracture independent of other explanatory factors. No such risk appears to be present in men, although their total hip BMD is lower in association with albuminuria.
KeywordsAlbuminuria BMD DEXA Elderly Hip fracture
The research reported in this article was supported by contract numbers N01-HC-85079 through N01-HC-85086, N01-HC-35129, N01 HC-15103, N01 HC-55222, N01-HC-75150, and N01-HC-45133, grant number U01 HL080295 from the National Heart, Lung, and Blood Institute, with additional contribution from the National Institute of Neurological Disorders and Stroke. A full list of principal CHS investigators and institutions can be found at http://www.chs-nhlbi.org/pi.htm.
Conflicts of interest
- 3.Barzilay JI, Peterson D, Cushman M, Heckbert SR, Cao JJ, Blaum C, Tracy RP, Klein R, Herrington DM (2004) The relationship of cardiovascular risk factors to microalbuminuria in older adults with or without diabetes mellitus or hypertension; the Cardiovascular Health Study. Am J Kidney Dis 44:25–34PubMedCrossRefGoogle Scholar
- 5.Burkhardt R, Kettner G, Böhm W, Schmidmeier M, Schlag R, Frisch B, Mallmann B, Eisenmenger W, Gilg T (1987) Changes in trabecular bone, hematopoiesis and bone marrow vessels in aplastic anemia, primary osteoporosis, and old age: a comparative histomorphometric study. Bone 8:157–164PubMedCrossRefGoogle Scholar
- 7.Laroche M, Ludot I, Thiechart M, Arlet J, Pieraggi M, Chiron P, Moulinier L, Cantagrel A, Puget J, Utheza G, Mazieres B (1995) Study of the intraosseous vessels of the femoral head in patients with fractures of the femoral neck or osteoarthritis of the hip. Osteoporos Int 5:213–217PubMedCrossRefGoogle Scholar
- 11.Barzilay JI, Gao P, Clase K, Mente A, Mann JFE, Sleight P, Yusuf S, Teo KK, on behalf of the ONTARGET/TRANSCEND Investigators (2013) Albuminuria and rapid loss of glomerular filtration rate predict new hip and pelvic fractures: the ONTARGET/TRANSCEND studies. Clin J Am Soc Nephrol 8:233–240PubMedCrossRefGoogle Scholar
- 16.R Development Core Team (2009) R: a language and environment for statistical computing. R Foundation for Statistical Computing: Vienna. ISBN 3-900051-07-0. http://www.R-project.org