Hemoglobin levels improve fracture risk prediction in addition to FRAX® clinical risk factors and bone mineral density
Hemoglobin levels improve fracture risk prediction in addition to FRAX® clinical risk factors and bone mineral density
Context: anemia and decreasing levels of hemoglobin (Hb) have previously been linked to increased fracture risk, but the added value to FRAX®, the most utilized fracture prediction tool worldwide, is unknown.
Objectives: to investigate the association between anemia, Hb levels, bone microstructure, and risk of incident fracture and to evaluate if Hb levels improve fracture risk prediction in addition to FRAX clinical risk factors (CRFs).
Methods: a total of 2778 community-dwelling women, aged 75-80 years and part of a prospective population-based cohort study in Sweden were included. At baseline, information on anthropometrics, CRFs and falls was gathered, blood samples were collected, and skeletal characteristics were investigated using dual energy x-ray absorptiometry and high-resolution peripheral quantitative computed tomography. At the end of follow-up, incident fractures were retrieved from a regional x-ray archive.
Results: the median follow-up time was 6.4 years. Low Hb was associated with worse total hip and femoral neck bone mineral density (BMD), lower tibia cortical and total volumetric BMD, and anemia was associated with increased risk of major osteoporotic fracture (MOF; hazard ratio 2.04; 95% CI 1.58-2.64). Similar results were obtained for hip fracture and any fracture, also when adjusting for CRFs. The ratio between 10-year fracture probabilities of MOF assessed in models with Hb levels included to not included, ranged from 1.2 to 0.7 at the 10th and 90th percentile of Hb, respectively.
Conclusions: anemia and decreasing levels of Hb are associated with lower cortical BMD and incident fracture in older women. Considering Hb levels may improve the clinical evaluation of patients with osteoporosis and the assessment of fracture risk.
anemia, fracture risk, fracture risk assessment, hemoglobin level, older women
e1479-e1488
Jaiswal, Raju
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Johansson, Helena
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Axelsson, Kristian F.
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Magnusson, Per
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Harvey, Nicholas C.
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Vandenput, Liesbeth
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McCloskey, Eugene
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Kanis, John A.
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Litsne, Henrik
e95cdd34-5e70-482e-a53c-45189411cd14
Johansson, Lisa
54820beb-ecca-43fd-9208-283c2fef0f3d
Lorentzon, Mattias
9d78ed25-2b0c-46c5-a2db-a8b246af0956
5 July 2023
Jaiswal, Raju
b8b456f3-ccfe-4543-a09b-34ecc5b944a1
Johansson, Helena
04f12338-4dd1-437b-b9bc-e0884130c215
Axelsson, Kristian F.
1b319953-04ae-4f73-b221-dd56fd312993
Magnusson, Per
4e78da9a-634a-4bf2-97cf-a1701351fc8d
Harvey, Nicholas C.
ce487fb4-d360-4aac-9d17-9466d6cba145
Vandenput, Liesbeth
0910d143-4b58-4579-82b0-3810272f1814
McCloskey, Eugene
3a2fac33-b400-4ae3-a212-04c3c3d2a517
Kanis, John A.
f1621d8d-8afb-4d97-9679-2165d88a344d
Litsne, Henrik
e95cdd34-5e70-482e-a53c-45189411cd14
Johansson, Lisa
54820beb-ecca-43fd-9208-283c2fef0f3d
Lorentzon, Mattias
9d78ed25-2b0c-46c5-a2db-a8b246af0956
Jaiswal, Raju, Johansson, Helena, Axelsson, Kristian F., Magnusson, Per, Harvey, Nicholas C., Vandenput, Liesbeth, McCloskey, Eugene, Kanis, John A., Litsne, Henrik, Johansson, Lisa and Lorentzon, Mattias
(2023)
Hemoglobin levels improve fracture risk prediction in addition to FRAX® clinical risk factors and bone mineral density.
Journal of Clinical Endocrinology & Metabolism, 108 (12), .
(doi:10.1210/clinem/dgad399).
Abstract
Context: anemia and decreasing levels of hemoglobin (Hb) have previously been linked to increased fracture risk, but the added value to FRAX®, the most utilized fracture prediction tool worldwide, is unknown.
Objectives: to investigate the association between anemia, Hb levels, bone microstructure, and risk of incident fracture and to evaluate if Hb levels improve fracture risk prediction in addition to FRAX clinical risk factors (CRFs).
Methods: a total of 2778 community-dwelling women, aged 75-80 years and part of a prospective population-based cohort study in Sweden were included. At baseline, information on anthropometrics, CRFs and falls was gathered, blood samples were collected, and skeletal characteristics were investigated using dual energy x-ray absorptiometry and high-resolution peripheral quantitative computed tomography. At the end of follow-up, incident fractures were retrieved from a regional x-ray archive.
Results: the median follow-up time was 6.4 years. Low Hb was associated with worse total hip and femoral neck bone mineral density (BMD), lower tibia cortical and total volumetric BMD, and anemia was associated with increased risk of major osteoporotic fracture (MOF; hazard ratio 2.04; 95% CI 1.58-2.64). Similar results were obtained for hip fracture and any fracture, also when adjusting for CRFs. The ratio between 10-year fracture probabilities of MOF assessed in models with Hb levels included to not included, ranged from 1.2 to 0.7 at the 10th and 90th percentile of Hb, respectively.
Conclusions: anemia and decreasing levels of Hb are associated with lower cortical BMD and incident fracture in older women. Considering Hb levels may improve the clinical evaluation of patients with osteoporosis and the assessment of fracture risk.
Text
dgad399
- Accepted Manuscript
More information
Accepted/In Press date: 3 July 2023
e-pub ahead of print date: 5 July 2023
Published date: 5 July 2023
Additional Information:
Publisher Copyright:
© The Author(s) 2023. Published by Oxford University Press on behalf of the Endocrine Society.
Keywords:
anemia, fracture risk, fracture risk assessment, hemoglobin level, older women
Identifiers
Local EPrints ID: 479847
URI: http://eprints.soton.ac.uk/id/eprint/479847
ISSN: 0021-972X
PURE UUID: 9f2ef796-48be-482a-a07d-19c6a304ba0c
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Date deposited: 27 Jul 2023 16:02
Last modified: 18 Mar 2024 02:59
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Contributors
Author:
Raju Jaiswal
Author:
Helena Johansson
Author:
Kristian F. Axelsson
Author:
Per Magnusson
Author:
Liesbeth Vandenput
Author:
Eugene McCloskey
Author:
John A. Kanis
Author:
Henrik Litsne
Author:
Lisa Johansson
Author:
Mattias Lorentzon
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