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Osteoporosis International

, Volume 24, Issue 12, pp 2993–3000 | Cite as

Albuminuria is associated with hip fracture risk in older adults: the cardiovascular health study

  • J. I. Barzilay
  • P. Bůžková
  • Z. Chen
  • I. H. de Boer
  • L. Carbone
  • N. N. Rassouli
  • H. A. Fink
  • J. A. Robbins
Original Article

Abstract

Summary

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.

Introduction

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.

Methods

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.

Results

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.

Conclusions

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.

Keywords

Albuminuria BMD DEXA Elderly Hip fracture 

Notes

Acknowledgments

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

None.

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Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2013

Authors and Affiliations

  • J. I. Barzilay
    • 1
    • 2
    • 9
  • P. Bůžková
    • 3
  • Z. Chen
    • 4
  • I. H. de Boer
    • 5
  • L. Carbone
    • 6
  • N. N. Rassouli
    • 1
    • 2
  • H. A. Fink
    • 7
  • J. A. Robbins
    • 8
  1. 1.Division of EndocrinologyKaiser Permanente of GeorgiaAtlantaUSA
  2. 2.Division of EndocrinologyEmory University School of MedicineAtlantaUSA
  3. 3.Department of BiostatisticsUniversity of WashingtonSeattleUSA
  4. 4.Division of Epidemiology and BiostatisticsThe University of Arizona Mel and Enid Zuckerman College of Public HealthTucsonUSA
  5. 5.Division of NephrologyUniversity of WashingtonSeattleUSA
  6. 6.Division of Connective Tissue DiseasesUniversity of Tennessee Health Science Center and Department of Veterans Affairs Medical CenterMemphisUSA
  7. 7.Geriatric Research Education and Clinical CenterVeterans Affair Medical CenterMinneapolisUSA
  8. 8.Department of MedicineUniversity of CaliforniaSacramentoUSA
  9. 9.TuckerUSA

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