TY - JOUR
T1 - Older men with anemia have increased fracture risk independent of bone mineral density
AU - Valderrábano, Rodrigo J.
AU - Lee, Jennifer
AU - Lui, Li Yung
AU - Hoffman, Andrew R.
AU - Cummings, Steven R.
AU - Orwoll, Eric S.
AU - Wu, Joy Y.
N1 - Publisher Copyright:
Copyright © 2017 Endocrine Society.
PY - 2017/7/1
Y1 - 2017/7/1
N2 - Context: Extremely low hemoglobin (Hgb) values have been linked to increased fracture risk at different sites. However, careful assessment of clinically defined anemia and fracture risk is lacking. Objective: To determine whether men with anemia were at increased risk of fracture after accounting for bone mineral density (BMD) and bone loss. Design: Cross-sectional analysis (at visit 3) and prospective analysis (from baseline to visit 3) in the Osteoporotic Fractures in Men (MrOS), a multisite, longitudinal cohort study. Setting: Six communities in the United States. Participants: A total of 3632 community-dwelling men (age 65 years) in MrOS at baseline (2000 through 2002) who were able to walk unassisted, did not have hip replacement or fracture, and had complete blood cell counts at visit 3 (2007 through 2009). Outcomes: Adjudicated spine and nonspine fractures during a median 7.2 years of follow-up. Results: Analytic baseline characteristics associated with fractures or anemia (defined as Hgb,12 g/dL) were included in multivariable models. Anemia was associated with increased risk of any fracture [hazard ratio (HR), 1.67;95%confidence interval (CI), 1.26 to 2.21] and nonspine fracture (HR, 1.70;95% CI, 1.25 to 2.31). A model including change in BMD slightly attenuated the association with any (HR, 1.60; 95% CI, 1.20 to 2.13) and nonspine fractures (HR, 1.57; 95% CI, 1.14 to 2.15). Including absolute BMD did not significantly alter the anemia-fracture association. Anemia was not associated with spine fracture. Conclusions: Community-dwelling older men with anemia had a 57% to 72% increase in nonspine fracture risk independent of BMD and bone loss.
AB - Context: Extremely low hemoglobin (Hgb) values have been linked to increased fracture risk at different sites. However, careful assessment of clinically defined anemia and fracture risk is lacking. Objective: To determine whether men with anemia were at increased risk of fracture after accounting for bone mineral density (BMD) and bone loss. Design: Cross-sectional analysis (at visit 3) and prospective analysis (from baseline to visit 3) in the Osteoporotic Fractures in Men (MrOS), a multisite, longitudinal cohort study. Setting: Six communities in the United States. Participants: A total of 3632 community-dwelling men (age 65 years) in MrOS at baseline (2000 through 2002) who were able to walk unassisted, did not have hip replacement or fracture, and had complete blood cell counts at visit 3 (2007 through 2009). Outcomes: Adjudicated spine and nonspine fractures during a median 7.2 years of follow-up. Results: Analytic baseline characteristics associated with fractures or anemia (defined as Hgb,12 g/dL) were included in multivariable models. Anemia was associated with increased risk of any fracture [hazard ratio (HR), 1.67;95%confidence interval (CI), 1.26 to 2.21] and nonspine fracture (HR, 1.70;95% CI, 1.25 to 2.31). A model including change in BMD slightly attenuated the association with any (HR, 1.60; 95% CI, 1.20 to 2.13) and nonspine fractures (HR, 1.57; 95% CI, 1.14 to 2.15). Including absolute BMD did not significantly alter the anemia-fracture association. Anemia was not associated with spine fracture. Conclusions: Community-dwelling older men with anemia had a 57% to 72% increase in nonspine fracture risk independent of BMD and bone loss.
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U2 - 10.1210/jc.2017-00266
DO - 10.1210/jc.2017-00266
M3 - Article
C2 - 28368469
AN - SCOPUS:85023172768
SN - 0021-972X
VL - 102
SP - 2199
EP - 2206
JO - Journal of Clinical Endocrinology and Metabolism
JF - Journal of Clinical Endocrinology and Metabolism
IS - 7
ER -