Osteoporosis International

, Volume 25, Issue 7, pp 1831–1836 | Cite as

Waning predictive value of serum adiponectin for fracture risk in elderly men: MrOS Sweden

  • H. JohanssonEmail author
  • A. Odén
  • M. K. Karlsson
  • E. McCloskey
  • J. A. Kanis
  • C. Ohlsson
  • D. Mellström
Original Article



Serum adiponectin is a risk factor for fracture. The predictive value attenuates with time in elderly men so that its use for the risk assessment in the long term is questionable. The study underlines the importance of testing the long-term stability of potential risk factors.


High serum adiponectin is associated with an increased risk of fracture in elderly men. The aim of the present study was to determine the impact of adiponectin on the probability of fracture as a function of time.


The probability of osteoporotic fracture was computed in 989 elderly men from the MrOS study in Sweden. Baseline data included clinical risk factors for fracture, femoral neck BMD and serum adiponectin. Men were followed for up to 7.4 years with a mean follow up of 5.3 years (range 0.0–7.4 years). Poisson regression was used to model the hazard function for osteoporotic fracture and death to determine the 10 year probability of fracture.


During follow up, 124 men sustained one or more osteoporotic fracture. There was a significant interaction between adiponectin and time since baseline (p = 0.026) such that the longer time since baseline, the lower the gradient of fracture risk. When using this interaction in the calculation of 10-year probability of fracture, the probabilities of osteoporotic fracture varied little over the range of adiponectin values.


Serum adiponectin is a risk factor for fracture. Nevertheless, the predictive value attenuates with time so that its use for the risk assessment in the long term is questionable. This study underlines the importance of testing the long-term stability of potential risk factors that might be used in fracture risk assessment.


Adiponectin Elderly men Probability of fracture Osteoporotic fracture 



HJ was supported by an ESCEO-AMGEN Osteoporosis Fellowship Award. Amgen had no input into the analysis plan or in the writing of this report.

Conflicts of interest



  1. 1.
    Consensus development conference: diagnosis, prophylaxis, and treatment of osteoporosis (1993). Am J Med 94 (6):646–650.Google Scholar
  2. 2.
    Assessment of fracture risk and its application to screening for postmenopausal osteoporosis. Report of a WHO Study Group (1994). World Health Organ Tech Rep Ser 843:1–129Google Scholar
  3. 3.
    Kanis JA on behalf of the World Health Organization Scientific Group (2008) Assessment of osteoporosis at the primary health-care level, Technical Report. WHO Collaborating Centre, University of Sheffield, UKGoogle Scholar
  4. 4.
    Kanis JA, Oden A, Johnell O, Johansson H, De Laet C, Brown J, Burckhardt P, Cooper C, Christiansen C, Cummings S, Eisman JA, Fujiwara S, Gluer C, Goltzman D, Hans D, Krieg MA, La Croix A, McCloskey E, Mellstrom D, Melton LJ 3rd, Pols H, Reeve J, Sanders K, Schott AM, Silman A, Torgerson D, van Staa T, Watts NB, Yoshimura N (2007) The use of clinical risk factors enhances the performance of BMD in the prediction of hip and osteoporotic fractures in men and women. Osteoporos Int 18(8):1033–1046PubMedCrossRefGoogle Scholar
  5. 5.
    Leslie WD, Lix LM, Johansson H, Oden A, McCloskey E, Kanis JA (2011) Spine-hip discordance and fracture risk assessment: a physician-friendly FRAX enhancement. Osteoporos Int 22(3):839–847. doi: 10.1007/s00198-010-1461-5 PubMedCrossRefGoogle Scholar
  6. 6.
    Kanis JA, Johansson H, Oden A, McCloskey EV (2011) Guidance for the adjustment of FRAX according to the dose of glucocorticoids. Osteoporos Int 22(3):809–816. doi: 10.1007/s00198-010-1524-7 PubMedCrossRefGoogle Scholar
  7. 7.
    Luo XH, Guo LJ, Yuan LQ, Xie H, Zhou HD, Wu XP, Liao EY (2005) Adiponectin stimulates human osteoblasts proliferation and differentiation via the MAPK signaling pathway. Exp Cell Res 309(1):99–109. doi: S0014-4827(05)00252-1 [pii] 10.1016/j.yexcr.2005.05.021 PubMedCrossRefGoogle Scholar
  8. 8.
    Johansson H, Oden A, Lerner UH, Jutberger H, Lorentzon M, Barrett-Connor E, Karlsson MK, Ljunggren O, Smith U, McCloskey E, Kanis JA, Ohlsson C, Mellstrom D (2012) High serum adiponectin predicts incident fractures in elderly men: osteoporotic fractures in men (MrOS) Sweden. J Bone Miner Res 27(6):1390–1396. doi: 10.1002/jbmr.1591 PubMedCrossRefGoogle Scholar
  9. 9.
    Orwoll E, Blank JB, Barrett-Connor E, Cauley J, Cummings S, Ensrud K, Lewis C, Cawthon PM, Marcus R, Marshall LM, McGowan J, Phipps K, Sherman S, Stefanick ML, Stone K (2005) Design and baseline characteristics of the osteoporotic fractures in men (MrOS) study—a large observational study of the determinants of fracture in older men. Contemp Clin Trials 26(5):569–585. doi: 10.1016/j.cct.2005.05.006 PubMedCrossRefGoogle Scholar
  10. 10.
    Mellstrom D, Vandenput L, Mallmin H, Holmberg AH, Lorentzon M, Oden A, Johansson H, Orwoll ES, Labrie F, Karlsson MK, Ljunggren O, Ohlsson C (2008) Older men with low serum estradiol and high serum SHBG have an increased risk of fractures. J Bone Miner Res 23(10):1552–1560. doi: 10.1359/jbmr.080518 PubMedCrossRefGoogle Scholar
  11. 11.
    Mellstrom D, Johnell O, Ljunggren O, Eriksson AL, Lorentzon M, Mallmin H, Holmberg A, Redlund-Johnell I, Orwoll E, Ohlsson C (2006) Free testosterone is an independent predictor of BMD and prevalent fractures in elderly men: MrOS Sweden. J Bone Miner Res 21(4):529–535. doi: 10.1359/jbmr.060110 PubMedCrossRefGoogle Scholar
  12. 12.
    Kanis JA, Oden A, Johnell O, Jonsson B, de Laet C, Dawson A (2001) The burden of osteoporotic fractures: a method for setting intervention thresholds. Osteoporos Int 12(5):417–427PubMedCrossRefGoogle Scholar
  13. 13.
    Breslow NE, Day NE (1987) Statistical methods in cancer research. IARC Sci Publ No 32 Volume II:131–135Google Scholar
  14. 14.
    Kanis JA, Johnell O, Oden A, Johansson H, McCloskey E (2008) FRAX and the assessment of fracture probability in men and women from the UK. Osteoporos Int 19(4):385–397PubMedCentralPubMedCrossRefGoogle Scholar
  15. 15.
    Barbour KE, Zmuda JM, Boudreau R, Strotmeyer ES, Horwitz MJ, Evans RW, Kanaya AM, Harris TB, Bauer DC, Cauley JA (2011) Adipokines and the risk of fracture in older adults. J Bone Miner Res 26(7):1568–1576. doi: 10.1002/jbmr.361 PubMedCentralPubMedCrossRefGoogle Scholar
  16. 16.
    Araneta MR, von Muhlen D, Barrett-Connor E (2009) Sex differences in the association between adiponectin and BMD, bone loss, and fractures: the Rancho Bernardo study. J Bone Miner Res 24(12):2016–2022. doi: 10.1359/jbmr.090519 PubMedCentralPubMedCrossRefGoogle Scholar
  17. 17.
    Kanazawa I, Yamaguchi T, Yamamoto M, Yamauchi M, Yano S, Sugimoto T (2009) Relationships between serum adiponectin levels versus bone mineral density, bone metabolic markers, and vertebral fractures in type 2 diabetes mellitus. Eur J Endocrinol 160(2):265–273. doi: 10.1530/eje-08-0642 PubMedCrossRefGoogle Scholar
  18. 18.
    Johnell O, Oden A, Caulin F, Kanis JA (2001) Acute and long-term increase in fracture risk after hospitalization for vertebral fracture. Osteoporos Int 12(3):207–214PubMedCrossRefGoogle Scholar
  19. 19.
    Johnell O, Kanis JA, Oden A, Sernbo I, Redlund-Johnell I, Petterson C, De Laet C, Jonsson B (2004) Fracture risk following an osteoporotic fracture. Osteoporos Int 15(3):175–179. doi: 10.1007/s00198-003-1514-0 PubMedCrossRefGoogle Scholar
  20. 20.
    Johansson H, Oden A, Karlsson MK, Rosengren B, Ljunggren O, McCloskey E, Kanis J, Ohlsson C, Mellstrom D (2013) FRAX predicts future falls in elderly men. MrOs Sweden. JBMR 28((Suppl 1):S166Google Scholar
  21. 21.
    Johansson H, Oden A, Kanis J, McCloskey E, Lorentzon M, Ljunggren O, Karlsson MK, Thorsby PM, Tivesten A, Barrett-Connor E, Ohlsson C, Mellstrom D (2011) Low serum vitamin D is associated with increased mortality in elderly men: MrOS Sweden. Osteoporos Int. doi: 10.1007/s00198-011-1809-5 PubMedCentralGoogle Scholar
  22. 22.
    Luukinen H, Kakonen SM, Pettersson K, Koski K, Laippala P, Lovgren T, Kivela SL, Vaananen HK (2000) Strong prediction of fractures among older adults by the ratio of carboxylated to total serum osteocalcin. J Bone Miner Res 15(12):2473–2478. doi: 10.1359/jbmr.2000.15.12.2473 PubMedCrossRefGoogle Scholar
  23. 23.
    Ivaska KK, Gerdhem P, Vaananen HK, Akesson K, Obrant KJ (2010) Bone turnover markers and prediction of fracture: a prospective follow-up study of 1040 elderly women for a mean of 9 years. J Bone Miner Res 25(2):393–403. doi: 10.1359/jbmr.091006 PubMedCrossRefGoogle Scholar
  24. 24.
    Ivaska K, McGuigan F, Obrant K, Gerdhem P, Akesson K (2013) Bone turnover markers and prediction of fractures in a 15-year follow-up study of elderly women. JBMR 28(Suppl 1):s34Google Scholar
  25. 25.
    Kanis JA, Johnell O, Oden A, Jonsson B, De Laet C, Dawson A (2000) Prediction of fracture from low bone mineral density measurements overestimates risk. Bone 26(4):387–391. doi: S8756-3282(00)00238-6 [pii] 10.1016/S8756-3282(00)00238-6 PubMedCrossRefGoogle Scholar
  26. 26.
    Johnell O, Kanis JA, Oden A, Johansson H, De Laet C, Delmas P, Eisman JA, Fujiwara S, Kroger H, Mellstrom D, Meunier PJ, Melton LJ 3rd, O’Neill T, Pols H, Reeve J, Silman A, Tenenhouse A (2005) Predictive value of BMD for hip and other fractures. J Bone Miner Res 20(7):1185–1194. doi: 10.1359/JBMR.050304 PubMedCrossRefGoogle Scholar

Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2014

Authors and Affiliations

  • H. Johansson
    • 1
    • 3
    Email author
  • A. Odén
    • 1
    • 3
  • M. K. Karlsson
    • 2
  • E. McCloskey
    • 3
  • J. A. Kanis
    • 3
  • C. Ohlsson
    • 1
  • D. Mellström
    • 1
  1. 1.Centre for Bone and Arthritis Research (CBAR), Sahlgrenska AcademyUniversity of GothenburgGothenburgSweden
  2. 2.Clinical and Molecular Osteoporosis Research Unit, Department of Orthopedics and Clinical SciencesLund University, Skane University HospitalMalmoSweden
  3. 3.WHO Collaborating Centre for Metabolic Bone DiseasesUniversity of SheffieldSheffieldUK

Personalised recommendations