title: Association of kidney function with incident hip fracture in older adults.
abstract: Kidney dysfunction is associated with bone loss, and patients with ESRD have an increased risk for hip fracture. However, the association of mild to moderate kidney disease with hip fracture has not been studied previously. The association of kidney function with incident hip fracture was examined among participants in the Cardiovascular Health Study, a community-based cohort of older individuals. The primary measure of kidney function was serum cystatin C, a measure that does not depend on lean mass. Hip fractures were identified using International Classification of Diseases, Ninth Revision codes for hospitalizations. A total of 4699 individuals had cystatin C measured in 1992 to 1993 and did not have a hip fracture before cystatin C measurement. The association of kidney function with hip fracture was analyzed with Cox proportional hazards models. Analyses were conducted separately for men and women. After a mean follow-up of 7.1 yr, 195 incident hip fractures occurred in women and 79 occurred in men. Higher cystatin C levels were associated with a higher risk for fracture in women (hazard ratio [HR] 1.26; 95% confidence interval [CI] 1.14 to 1.38 per SD) and in men (HR 1.27; 95% CI 1.11 to 1.46). After multivariable adjustment, higher cystatin C levels were significantly associated with hip fracture in women (HR 1.16; 95% CI 1.01, 1.33) but not in men (HR 1.14; 95% CI 0.86 to 1.52), although the magnitude of the association was similar. Kidney dysfunction, as assessed by cystatin C, is associated with an increased risk for hip fracture. Further studies are needed to evaluate potential mediators of this relationship and to assess whether interventions can decrease this risk.
authors.affiliation: VA Pittsburgh Healthcare System, Pittsburgh, PA 15240, USA. linda.fried@med.va.gov
authors.forename: Linda F
authors.initials: LF
authors.lastname: Fried
authors.forename: Mary Louise
authors.initials: ML
authors.lastname: Biggs
authors.forename: Michael G
authors.initials: MG
authors.lastname: Shlipak
authors.forename: Stephen
authors.initials: S
authors.lastname: Seliger
authors.forename: Bryan
authors.initials: B
authors.lastname: Kestenbaum
authors.forename: Catherine
authors.initials: C
authors.lastname: Stehman-Breen
authors.forename: Mark
authors.initials: M
authors.lastname: Sarnak
authors.forename: David
authors.initials: D
authors.lastname: Siscovick
authors.forename: Tamara
authors.initials: T
authors.lastname: Harris
authors.forename: Jane
authors.initials: J
authors.lastname: Cauley
authors.forename: Anne B
authors.initials: AB
authors.lastname: Newman
authors.forename: John
authors.initials: J
authors.lastname: Robbins
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D055316:Cystatin C; D015891:Cystatins / Q000097:blood; D005260:Female; D006620:Hip Fractures / Q000150:complications / Q000503:physiopathology*; D006801:Humans; D007668:Kidney / Q000503:physiopathology*; D007676:Kidney Failure, Chronic / Q000150:complications / Q000503:physiopathology; D008137:Longitudinal Studies; D008297:Male; D010024:Osteoporosis / Q000150:complications / Q000503:physiopathology; D011446:Prospective Studies; D012307:Risk Factors; D012737:Sex Factors
chemical_list: C525030:CST3 protein, human; D055316:Cystatin C; D015891:Cystatins