Albuminuria is associated with hip fracture risk in older adults: the cardiovascular health study

Abstract

The microcirculation plays an important role in bone health. Here, we examine whether albuminuria, a marker of renal microvascular disease, is associated with the risk of hip fracture in older adults (age, 78years). We find a small independent association in women but not in men. The microvascular circulation plays an important role in bone physiology. Two studies of middle-aged adults have found that albuminuria (>30mg albumin/g creatinine), a disorder of the renal microvasculature, is associated with fracture risk. Here, we examine whether albuminuria is related to hip fracture risk and reduced hip bone mineral density (BMD) in older adults with a mean age of 78years. From the Cardiovascular Health Study (41% male), 3,110 adults with albuminuria testing were followed up for incident hip fracture for up to 9.5years. BMD was performed in a subset of 1,208 participants. There were 313 hip fractures during follow-up (7.7% of men; 11.7% of women). The incidence rate for men, with and without albuminuria, was 1.43 and 0.93/100 person-years of follow-up (p = 0.02); for women, 1.84 and 1.33 (p = 0.04). After adjustment for osteoporosis-related factors, frailty and falling, a doubling of albuminuria was significantly associated with hip fracture risk in women (hazard ratio, 1.12, 95% CI, 1.001-1.25), but not in men. In the subcohort with BMD measurement, increased urine albumin levels were significantly associated with decreased total hip BMD in men (-0.009g calcium/cm(2) (-0.017, -0.001); p = 0.04), but not in women. In older women, albuminuria is associated with a small, but statistically significant, increased risk of hip fracture independent of other explanatory factors. No such risk appears to be present in men, although their total hip BMD is lower in association with albuminuria.