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Older Men With Anemia Have Increased Fracture Risk Independent of Bone Mineral Density.
J Clin Endocrinol Metab. 2017 07 01; 102(7):2199-2206.JC

Abstract

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.

Authors+Show Affiliations

Division of Endocrinology, Stanford University School of Medicine, Stanford, California 94305.Division of Endocrinology, Stanford University School of Medicine, Stanford, California 94305. Palo Alto Veteran Affairs Health Care System, Palo Alto, California 94304.San Francisco Coordinating Center, California Pacific Medical Center, San Francisco, California 94159.Division of Endocrinology, Stanford University School of Medicine, Stanford, California 94305. Palo Alto Veteran Affairs Health Care System, Palo Alto, California 94304.San Francisco Coordinating Center, California Pacific Medical Center, San Francisco, California 94159.Department of Medicine, Bone and Mineral Unit, Oregon Health and Science University, Portland, Oregon 97239.Division of Endocrinology, Stanford University School of Medicine, Stanford, California 94305.No affiliation info available

Pub Type(s)

Journal Article
Multicenter Study
Observational Study
Research Support, N.I.H., Extramural

Language

eng

PubMed ID

28368469

Citation

Valderrábano, Rodrigo J., et al. "Older Men With Anemia Have Increased Fracture Risk Independent of Bone Mineral Density." The Journal of Clinical Endocrinology and Metabolism, vol. 102, no. 7, 2017, pp. 2199-2206.
Valderrábano RJ, Lee J, Lui LY, et al. Older Men With Anemia Have Increased Fracture Risk Independent of Bone Mineral Density. J Clin Endocrinol Metab. 2017;102(7):2199-2206.
Valderrábano, R. J., Lee, J., Lui, L. Y., Hoffman, A. R., Cummings, S. R., Orwoll, E. S., & Wu, J. Y. (2017). Older Men With Anemia Have Increased Fracture Risk Independent of Bone Mineral Density. The Journal of Clinical Endocrinology and Metabolism, 102(7), 2199-2206. https://doi.org/10.1210/jc.2017-00266
Valderrábano RJ, et al. Older Men With Anemia Have Increased Fracture Risk Independent of Bone Mineral Density. J Clin Endocrinol Metab. 2017 07 1;102(7):2199-2206. PubMed PMID: 28368469.
* Article titles in AMA citation format should be in sentence-case
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, AU - ,, PY - 2017/01/26/received PY - 2017/03/15/accepted PY - 2017/4/4/pubmed PY - 2017/10/3/medline PY - 2017/4/4/entrez SP - 2199 EP - 2206 JF - The Journal of clinical endocrinology and metabolism JO - J Clin Endocrinol Metab VL - 102 IS - 7 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. SN - 1945-7197 UR - https://www.unboundmedicine.com/medline/citation/28368469/Older_Men_With_Anemia_Have_Increased_Fracture_Risk_Independent_of_Bone_Mineral_Density_ L2 - https://academic.oup.com/jcem/article-lookup/doi/10.1210/jc.2017-00266 DB - PRIME DP - Unbound Medicine ER -