C-reactive protein predicts incident fracture in community-dwelling elderly Japanese women: the Muramatsu study

Abstract

Summary

In a 6-year cohort study of 751 community-dwelling elderly Japanese women, we found that C-reactive protein (CRP) is a significant predictor of osteoporotic fracture in elderly Asian women, who have significantly lower CRP levels than Caucasians. Mechanisms explaining such an association should be further studied.

Introduction

While CRP, a systemic inflammation marker, is thought to be associated with osteoporosis, evidence supporting this claim has been limited. We aimed to assess the association between CRP levels and incident osteoporotic fracture in elderly women.

Methods

We conducted a cohort study with a follow-up period of 6 years. The study included 751 Japanese women aged 69 years or older. We measured serum high-sensitivity CRP (hs-CRP) levels as a major predictor. Covariates included age, body mass index, forearm bone mineral density, calcium intake, serum 25-hydroxyvitamin D, postural sway, osteoporosis medication, and physical activity. The primary outcome was incident limb and vertebral fractures. The Cox proportional hazards model was used to calculate the hazard ratio (HR) of fracture.

Results

Median hs-CRP values in study participants were 0.16 mg/L in the lowest tertile, 0.36 mg/L in the medium tertile, and 1.14 mg/L in the highest tertile. The hs-CRP values in these women were substantially lower than in their Caucasian counterparts. Limb or vertebral fractures occurred in 50 subjects during 4,250 person-years. Low CRP levels were associated with low incidence of limb or vertebral fractures (P for trend = 0.035). The adjusted HRs of fracture for the medium and highest quartiles of hs-CRP levels, compared to the lowest quartile, were 2.22 (95% CI, 1.02–4.84) and 2.40 (95% CI, 1.10–5.24), respectively.

Conclusions

CRP is a significant predictor of osteoporotic fracture in elderly Asian women who have substantially lower CRP levels than Caucasians. Mechanisms explaining such an association should be further studied.

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Acknowledgements

We wish to thank the staff of the Muramatsu Health Center for their help with data collection. We are also grateful to the following institutions for providing us with necessary medical data: Igarashi Orthopaedic Clinic, Ishizone Clinic, Ito Clinic, Kaneko Clinic, Kasahara Clinic, Koyama Orthopaedic Clinic, Nanbugo General Hospital, Nanbugo Kosei Hospital, Murata Clinic, Takeda Clinic, Yamamura Orthopaedic Clinic in Gosen City, Kaetsu Hospital, Kameda-Daiichi Hospital, Nekoyama Miyao Hospital in Niigata City, and Tominaga Kusano Hospital in Sanjo City. This study was supported in part by a Grant-in-Aid for Scientific Research (C) No.40339958 from the Japanese Ministry of Education, Culture, Sports, Science and Technology.

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Correspondence to K. Nakamura.

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Nakamura, K., Saito, T., Kobayashi, R. et al. C-reactive protein predicts incident fracture in community-dwelling elderly Japanese women: the Muramatsu study. Osteoporos Int 22, 2145–2150 (2011). https://doi.org/10.1007/s00198-010-1425-9

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Keywords

  • Aged
  • Cohort studies
  • C-reactive protein
  • Fractures
  • Osteoporosis