Abstract
Elevated red blood cell distribution width (RDW), a simple measure of red blood cell size heterogeneity, has been associated with increased mortality and morbidity in the elderly population, which might reflect systemic inflammation and malnutrition. However, whether elevated RDW is associated with prevalent morphometric vertebral fracture (VF) in older adults has not been investigated. We examined 2127 individuals (mean age 71.7 years; women 66%) from a community-based cohort. VF was defined as ≥ 25% reduction in vertebral column height using the Genant semiquantitative method. Multiple VF was defined as the presence of VF at two or more sites. The prevalence of any VF and multiple VF was 14% and 4%, respectively, increasing from the lowest to the highest RDW tertiles (12–18% and 3–6%, p for trend < 0.05 for all). RDW was positively associated with age, body mass index (BMI), malnutrition, and high-sensitivity C-reactive protein (hsCRP), whereas it was negatively associated with albumin, hemoglobin, and ferritin levels. Elevated RDW was associated with any VF [adjusted odds ratio (aOR) 1.26; p = 0.008] and multiple VF (aOR 1.36; p = 0.010) after adjustment for covariates, including age, sex, BMI, hsCRP, malnutrition, self-reported previous fracture, falls, osteoporosis, and hemoglobin and ferritin levels. The association between elevated RDW and VF remained robust in subgroups with (aOR 1.39; p = 0.048) or without anemia (aOR 1.26; p = 0.030). Elevated RDW was associated with prevalent morphometric VF in community-dwelling elderly individuals, independent of anemia, inflammation, and nutritional status.
Similar content being viewed by others
References
Evans TC, Jehle D (1991) The red blood cell distribution width. J Emerg Med 9(Suppl 1):71–74
Patel KV, Ferrucci L, Ershler WB, Longo DL, Guralnik JM (2009) Red blood cell distribution width and the risk of death in middle-aged and older adults. Arch Intern Med 169(5):515–523. https://doi.org/10.1001/archinternmed.2009.11
Felker GM, Allen LA, Pocock SJ, Shaw LK, McMurray JJ, Pfeffer MA, Swedberg K, Wang D, Yusuf S, Michelson EL, Granger CB, Investigators C (2007) Red cell distribution width as a novel prognostic marker in heart failure: data from the CHARM Program and the Duke Databank. J Am Coll Cardiol 50(1):40–47. https://doi.org/10.1016/j.jacc.2007.02.067
Patel KV, Semba RD, Ferrucci L, Newman AB, Fried LP, Wallace RB, Bandinelli S, Phillips CS, Yu B, Connelly S, Shlipak MG, Chaves PH, Launer LJ, Ershler WB, Harris TB, Longo DL, Guralnik JM (2010) Red cell distribution width and mortality in older adults: a meta-analysis. J Gerontol A 65(3):258–265. https://doi.org/10.1093/gerona/glp163
Perlstein TS, Weuve J, Pfeffer MA, Beckman JA (2009) Red blood cell distribution width and mortality risk in a community-based prospective cohort. Arch Intern Med 169(6):588–594. https://doi.org/10.1001/archinternmed.2009.55
Hong N, Oh J, Kang SM, Kim SY, Won H, Youn JC, Park S, Jang Y, Chung N (2012) Red blood cell distribution width predicts early mortality in patients with acute dyspnea. Clin Chim Acta 413(11–12):992–997. https://doi.org/10.1016/j.cca.2012.02.024
Tonelli M, Sacks F, Arnold M, Moye L, Davis B, Pfeffer M, for the C (2008) Relation between red blood cell distribution width and cardiovascular event rate in people with coronary disease. Recurr Events Trial Circ 117(2):163–168. https://doi.org/10.1161/CIRCULATIONAHA.107.727545I
Danese E, Lippi G, Montagnana M (2015) Red blood cell distribution width and cardiovascular diseases. J Thorac Dis 7(10):E402–E411. https://doi.org/10.3978/j.issn.2072-1439.2015.10.04
Lv H, Zhang L, Long A, Mao Z, Shen J, Yin P, Li M, Zeng C, Zhang L, Tang P (2016) Red Cell distribution width as an independent predictor of long-term mortality in hip fracture patients: a prospective cohort study. J Bone Miner Res 31(1):223–233. https://doi.org/10.1002/jbmr.2597
Garbharran U, Chinthapalli S, Hopper I, George M, Back DL, Dockery F (2013) Red cell distribution width is an independent predictor of mortality in hip fracture. Age Ageing 42(2):258–261. https://doi.org/10.1093/ageing/afs176
Burge R, Dawson-Hughes B, Solomon DH, Wong JB, King A, Tosteson A (2007) Incidence and economic burden of osteoporosis-related fractures in the United States, 2005–2025. J Bone Miner Res 22(3):465–475. https://doi.org/10.1359/jbmr.061113
Kendler DL, Bauer DC, Davison KS, Dian L, Hanley DA, Harris ST, McClung MR, Miller PD, Schousboe JT, Yuen CK, Lewiecki EM (2016) Vertebral fractures: clinical importance and management. Am J Med 129(2):221 e221–210. https://doi.org/10.1016/j.amjmed.2015.09.020
Cauley JA, Barbour KE, Harrison SL, Cloonan YK, Danielson ME, Ensrud KE, Fink HA, Orwoll ES, Boudreau R (2016) Inflammatory markers and the risk of hip and vertebral fractures in men: the osteoporotic fractures in men (MrOS). J Bone Miner Res 31(12):2129–2138. https://doi.org/10.1002/jbmr.2905
Compston JE (1992) Risk factors for osteoporosis. Clin Endocrinol 36(3):223–224
Lippi G, Targher G, Montagnana M, Salvagno GL, Zoppini G, Guidi GC (2009) Relation between red blood cell distribution width and inflammatory biomarkers in a large cohort of unselected outpatients. Arch Pathol Lab Med 133(4):628–632. https://doi.org/10.1043/1543-2165-133.4.628
Lee EY, Kim HC, Rhee Y, Youm Y, Kim KM, Lee JM, Choi DP, Yun YM, Kim CO (2014) The Korean urban rural elderly cohort study: study design and protocol. BMC Geriatr 14:33. https://doi.org/10.1186/1471-2318-14-33
Levey AS, Stevens LA, Schmid CH, Zhang YL, Castro AF 3rd, Feldman HI, Kusek JW, Eggers P, Van Lente F, Greene T, Coresh J (2009) A new equation to estimate glomerular filtration rate. Ann Intern Med 150(9):604–612
Cruz-Jentoft AJ, Baeyens JP, Bauer JM, Boirie Y, Cederholm T, Landi F, Martin FC, Michel JP, Rolland Y, Schneider SM, Topinkova E, Vandewoude M, Zamboni M, European Working Group on Sarcopenia in Older People (2010) Sarcopenia: European consensus on definition and diagnosis: report of the European Working Group on Sarcopenia in Older People. Age Ageing 39(4):412–423. https://doi.org/10.1093/ageing/afq034
Rubenstein LZ, Harker JO, Salva A, Guigoz Y, Vellas B (2001) Screening for undernutrition in geriatric practice: developing the short-form mini-nutritional assessment (MNA-SF). J Gerontol A 56(6):M366–M372
Pencina MJ, D’Agostino RB Sr, D’Agostino RB Jr, Vasan RS (2008) Evaluating the added predictive ability of a new marker: from area under the ROC curve to reclassification and beyond. Stat Med 27(2):157–172. https://doi.org/10.1002/sim.2929 (discussion 207–112)
Bazick HS, Chang D, Mahadevappa K, Gibbons FK, Christopher KB (2011) Red cell distribution width and all-cause mortality in critically ill patients. Crit Care Med 39(8):1913–1921. https://doi.org/10.1097/CCM.0b013e31821b85c6
Zalawadiya SK, Veeranna V, Niraj A, Pradhan J, Afonso L (2010) Red cell distribution width and risk of coronary heart disease events. Am J Cardiol 106(7):988–993. https://doi.org/10.1016/j.amjcard.2010.06.006
Soderholm M, Borne Y, Hedblad B, Persson M, Engstrom G (2015) Red cell distribution width in relation to incidence of stroke and carotid atherosclerosis: a population-based cohort study. PLoS ONE 10(5):e0124957. https://doi.org/10.1371/journal.pone.0124957
Emans ME, Gaillard CA, Pfister R, Tanck MW, Boekholdt SM, Wareham NJ, Khaw KT (2013) Red cell distribution width is associated with physical inactivity and heart failure, independent of established risk factors, inflammation or iron metabolism; the EPIC-Norfolk study. Int J Cardiol 168(4):3550–3555. https://doi.org/10.1016/j.ijcard.2013.05.002
Chen Z, Thomson CA, Aickin M, Nicholas JS, Van Wyck D, Lewis CE, Cauley JA, Bassford T, Short List of Women’s Health Initiative (2010) The relationship between incidence of fractures and anemia in older multiethnic women. J Am Geriatr Soc 58(12):2337–2344. https://doi.org/10.1111/j.1532-5415.2010.03183.x
Forhecz Z, Gombos T, Borgulya G, Pozsonyi Z, Prohaszka Z, Janoskuti L (2009) Red cell distribution width in heart failure: prediction of clinical events and relationship with markers of ineffective erythropoiesis, inflammation, renal function, and nutritional state. Am Heart J 158(4):659–666. https://doi.org/10.1016/j.ahj.2009.07.024
Jelkmann WE, Fandrey J, Frede S, Pagel H (1994) Inhibition of erythropoietin production by cytokines. Implications for the anemia involved in inflammatory states. Ann N Y Acad Sci 718:300–309 (discussion 309–311)
Macdougall IC, Cooper A (2002) The inflammatory response and epoetin sensitivity. Nephrol Dial Transplant 17(Suppl 1):48–52
Ferrucci L, Guralnik JM, Woodman RC, Bandinelli S, Lauretani F, Corsi AM, Chaves PH, Ershler WB, Longo DL (2005) Proinflammatory state and circulating erythropoietin in persons with and without anemia. Am J Med 118(11):1288. https://doi.org/10.1016/j.amjmed.2005.06.039
Pilling LC, Atkins JL, Duff MO, Beaumont RN, Jones SE, Tyrrell J, Kuo CL, Ruth KS, Tuke MA, Yaghootkar H, Wood AR, Murray A, Weedon MN, Harries LW, Kuchel GA, Ferrucci L, Frayling TM, Melzer D (2017) Red blood cell distribution width: genetic evidence for aging pathways in 116,666 volunteers. PLoS ONE 12(9):e0185083. https://doi.org/10.1371/journal.pone.0185083
Park EJ, Joo IW, Jang MJ, Kim YT, Oh K, Oh HJ (2014) Prevalence of osteoporosis in the Korean population based on Korea National Health and Nutrition Examination Survey (KNHANES), 2008–2011. Yonsei Med J 55(4):1049–1057. https://doi.org/10.3349/ymj.2014.55.4.1049
Lee J, Lee S, Jang S, Ryu OH (2013) Age-related changes in the prevalence of osteoporosis according to gender and skeletal site: the Korea National Health and Nutrition Examination Survey 2008–2010. Endocrinol Metab 28(3):180–191
Shin CS, Kim MJ, Shim SM, Kim JT, Yu SH, Koo BK, Cho HY, Choi HJ, Cho SW, Kim SW, Kim SY, Yang SO, Cho NH (2012) The prevalence and risk factors of vertebral fractures in Korea. J Bone Miner Metab 30(2):183–192. https://doi.org/10.1007/s00774-011-0300-x
Lippi G, Pavesi F, Bardi M, Pipitone S (2014) Lack of harmonization of red blood cell distribution width (RDW). Evaluation of four hematological analyzers. Clin Biochem 47(12):1100–1103. https://doi.org/10.1016/j.clinbiochem.2014.06.003
Scirica BM, Morrow DA, Cannon CP, de Lemos JA, Murphy S, Sabatine MS, Wiviott SD, Rifai N, McCabe CH, Braunwald E, Thrombolysis in Myocardial Infarction Study Group (2007) Clinical application of C-reactive protein across the spectrum of acute coronary syndromes. Clin Chem 53(10):1800–1807. https://doi.org/10.1373/clinchem.2007.087957
Acknowledgements
We thank all our participants and the technical staff of the KURE study.
Funding
This work was supported by the Research of Korea Centers for Disease Control and Prevention (Grant Numbers 2013-E63007-01, 2013-E63007-02).
Author information
Authors and Affiliations
Contributions
NH and YR designed the study and prepared the first draft of the paper. YR is guarantor. All authors participated in the KURE cohort study as steering committee members. COK, YY, and HCK were responsible for the integrity of data. NH was responsible for the statistical analysis of the data. J-YC reviewed and confirmed the interpretation of imaging dataset. All authors revised the paper critically for intellectual content and approved the final version. All authors agree to be accountable for the work and to ensure that any questions relating to the accuracy and integrity of the paper are investigated and properly resolved.
Corresponding author
Ethics declarations
Conflict of interest
Namki Hong, Chang Oh Kim, Yoosik Youm, Jin-Young Choi, Hyeon Chang Kim, and Yumie Rhee declare that they have no conflict of interest.
Human and Animal Rights and Informed Consent
The study was approved by the Institutional Review Board (IRB) of Severance Hospital (IRB No. 4-2012-0172), with written informed consent obtained from all participants. All procedures performed in studies involving human participants were in accordance with the ethical standards of the IRB and with the 1964 Helsinki Declaration and its later amendments.
Rights and permissions
About this article
Cite this article
Hong, N., Kim, C.O., Youm, Y. et al. Elevated Red Blood Cell Distribution Width Is Associated with Morphometric Vertebral Fracture in Community-Dwelling Older Adults, Independent of Anemia, Inflammation, and Nutritional Status: The Korean Urban Rural Elderly (KURE) Study. Calcif Tissue Int 104, 26–33 (2019). https://doi.org/10.1007/s00223-018-0470-9
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00223-018-0470-9