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

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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.

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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.

Author information

Authors and Affiliations

  1. Division of Endocrinology, Kaiser Permanente of Georgia, Atlanta, GA, USA

    J. I. Barzilay & N. N. Rassouli

  2. Division of Endocrinology, Emory University School of Medicine, Atlanta, GA, USA

    J. I. Barzilay & N. N. Rassouli

  3. Department of Biostatistics, University of Washington, Seattle, WA, USA

    P. Bůžková

  4. Division of Epidemiology and Biostatistics, The University of Arizona Mel and Enid Zuckerman College of Public Health, Tucson, AZ, USA

    Z. Chen

  5. Division of Nephrology, University of Washington, Seattle, WA, USA

    I. H. de Boer

  6. Division of Connective Tissue Diseases, University of Tennessee Health Science Center and Department of Veterans Affairs Medical Center, Memphis, TN, USA

    L. Carbone

  7. Geriatric Research Education and Clinical Center, Veterans Affair Medical Center, Minneapolis, MN, USA

    H. A. Fink

  8. Department of Medicine, University of California, Davis, Sacramento, CA, USA

    J. A. Robbins

  9. 200 Crescent Center Parkway, Tucker, GA, 30084, USA

    J. I. Barzilay

Authors
  1. J. I. Barzilay
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  2. P. Bůžková
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  3. Z. Chen
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  4. I. H. de Boer
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  5. L. Carbone
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  6. N. N. Rassouli
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  7. H. A. Fink
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  8. J. A. Robbins
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Corresponding author

Correspondence to J. I. Barzilay.

Appendix

Appendix

Table 5 Differences between the cohort excluded from DEXA scanning and the cohort with DXA scanning
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Barzilay, J.I., Bůžková, P., Chen, Z. et al. Albuminuria is associated with hip fracture risk in older adults: the cardiovascular health study. Osteoporos Int 24, 2993–3000 (2013). https://doi.org/10.1007/s00198-013-2389-3

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  • DOI: https://doi.org/10.1007/s00198-013-2389-3

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