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Association of hemoglobin level with fracture: a nationwide cohort study



The association between hemoglobin (Hb) level including anemia and fracture has not been studied thoroughly.

Materials and methods

197, 187 adults ≥ 50 years from the National Health Insurance Service of Korea were studied. Hb was determined during health screening examinations in 2004 or 2005. From 1 January 2006, participants were followed up for fracture until 31 December 2013. Hb levels (g/dL) were categorized into five groups, with normal hemoglobin levels subdivided into three groups (low normal, normal, and high normal Hb): < 13, ≥ 13 to < 14, ≥ 14 to < 16, ≥ 16 to < 17, 17 for men and < 12, ≥ 12 to < 13, ≥ 13 to < 14, ≥ 14 to < 16, ≥ 16 for women. Anemia was defined as Hb < 13 g/dL and < 12 g/dL for men and women, respectively. Cox proportional hazards regression was used to determine the adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs) for fracture according to Hb.


Compared to individuals with normal Hb, those with anemia and low normal Hb were associated with significantly increased risk of fracture. In women, those with anemia had a higher risk for any (aHR 1.11, 95% CI 1.05–1.17), hip (aHR 1.27, 95% CI 1.01–1.59), and radius fracture (aHR 1.15, 95% CI 1.05–1.25). In men, those with anemia had a higher risk for any (aHR 1.37, 95% CI 1.23–1.51), vertebral (aHR 1.33, 95% CI 1.15–1.53), and hip fracture (aHR 1.64, 95% CI 1.30–2.08). This risk-enhancing association was preserved among various subgroups.


Among adults ≥ 50 years, anemia and low normal Hb are risk factors for fracture.

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Fig. 1


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This study used the NHIS database (NHIS-2017-1-143).



Author information




SMP had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Conceptualization: JSK and SMP. Data curation: JSK, SC, and SMP. Formal analysis: JSK, SC, GL, SMP, Investigation: JSK. Methodology: JSK and SC. Resources: SMP. Software: SC. Supervision: SMP. Visualization: JSK. Writing—original draft: JSK, Writing—review and editing—JSK, SC, GL, YC, and SMP.

Corresponding author

Correspondence to Sang Min Park.

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All other authors have no conflicts of interest.

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Kim, J.S., Choi, S., Lee, G. et al. Association of hemoglobin level with fracture: a nationwide cohort study. J Bone Miner Metab 39, 833–842 (2021).

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  • Anemia
  • Hemoglobin level
  • Osteoporosis
  • Fracture