University of Miami Miller School of Medicine, P.O. Box 016960 (D-56), Miami, FL, 33101, USA.
Division of Endocrinology, Stanford University School of Medicine, 300 Pasteur Dr., S-025, Stanford, CA, 94305, USA.
Osteoporos Int. 2021 Aug;32(8):1669-1677. doi: 10.1007/s00198-021-05873-y. Epub 2021 Feb 12.
In a multi-site longitudinal cohort study, decreasing hemoglobin was associated with increased hip fracture risk in men. Anemia was associated with hip fracture in men and in African American women. Decreasing hemoglobin may be a marker of progressing bone fragility, making its serial measurement useful for fracture risk stratification.
Hematopoiesis and bone health are interdependent. Anemia has been associated with risk of fracture in humans. To further elucidate this relationship, we hypothesized that decreasing hemoglobin could indicate defective hematopoiesis and would also predict fracture risk.
We performed a prospective analysis from study baseline (1992) of the Cardiovascular Health Study, a multi-site longitudinal cohort study. A total of 4670 men and women, ages >65 years, who were able to consent and not institutionalized or wheelchair bound, had hemoglobin (Hb) measured in 1992. For 4006 subjects, Hb change from 1989 to 1992 was annualized and divided into sex-specific quartiles. Incident hip fractures were verified against Medicare claims data during a median follow-up of 11.8 years.
Nested Cox proportional-hazard models estimated association of hip fracture with anemia (men Hb <13 g/dL, women Hb <12 g/dL) and separately, greatest Hb decrease (versus others). Anemia was associated with increased hip fracture risk in all men (HR 1.59; 95% CI 1.01-2.50) and African American women (HR 3.21; 95% CI 1.07-9.63). In men, an annualized Hb loss of >0.36 g/dL/year was associated with a higher risk of hip fracture (HR 1.67; 95% CI 1.10-2.54), which was lessened by anemia at the start of fracture follow-up (HR 1.53; 95% CI 0.99-2.39).
Decreasing Hb may be an early marker for subsequent hip fracture risk in men, which may be less informative once an anemia threshold is crossed. Only African American women with anemia had increased hip fracture risk, suggesting a race difference in this relationship.
在一项多中心纵向队列研究中，血红蛋白降低与男性髋部骨折风险增加相关。贫血与男性和非裔美国女性的髋部骨折相关。血红蛋白降低可能是骨骼脆弱进展的标志物，因此连续测量其水平有助于进行骨折风险分层。
我们对心血管健康研究（一项多中心纵向队列研究）进行了前瞻性分析，该研究从基线（1992 年）开始。共纳入 4670 名年龄>65 岁、能够同意且未住院或坐轮椅的男性和女性，他们在 1992 年接受了血红蛋白（Hb）检测。对于 4006 名受试者，从 1989 年到 1992 年的 Hb 变化按性别分为四分位数。在中位随访 11.8 年期间，使用医疗保险索赔数据对髋部骨折的发生进行了验证。
嵌套 Cox 比例风险模型估计了髋部骨折与贫血（男性 Hb<13 g/dL，女性 Hb<12 g/dL）和最大 Hb 下降（与其他人相比）的关联。贫血与所有男性（HR 1.59；95%CI 1.01-2.50）和非裔美国女性（HR 3.21；95%CI 1.07-9.63）髋部骨折风险增加相关。在男性中，Hb 每年下降>0.36 g/dL/年与髋部骨折风险增加相关（HR 1.67；95%CI 1.10-2.54），但在骨折随访开始时存在贫血会减轻这种相关性（HR 1.53；95%CI 0.99-2.39）。
在男性中，Hb 降低可能是随后髋部骨折风险的早期标志物，但一旦达到贫血阈值，其信息含量可能会降低。只有非裔美国女性贫血与髋部骨折风险增加相关，提示这种相关性在种族之间存在差异。
