title: Cystatin C and risk of hip fractures in older women.
abstract: To test the hypothesis that older women with higher cystatin C are at increased risk of hip fracture independent of traditional risk factors including hip bone mineral density (BMD), we performed a case-cohort analysis nested in a cohort of 4709 white women attending a Year 10 (1997-1998) examination of the Study of Osteoporotic Fractures that included a random sample of 1170 women and the first 300 women with incident hip fracture occurring after Year 10 examination. Serum cystatin C and creatinine were measured in Year 10 sera. In a model adjusted for age, clinical site, body mass index, and total hip BMD, higher cystatin C was associated with an increased risk of hip fracture (p for linear trend 0.008) with women in quartile 4 having a 1.9-fold higher risk (hazard ratio [HR] 1.91; 95% confidence interval [CI], 1.24-2.95) compared with those in quartile 1 (referent group). Further adjustment for additional risk factors only slightly attenuated the association; the risk for hip fracture was 1.7-fold higher (HR 1.74; 95% CI, 1.11-2.72) in women in quartile 4 compared with those in quartile 1. In contrast, neither serum creatinine nor creatinine-based estimated glomerular filtration rate (eGFRCr ) were associated with risk of hip fracture. Older women with higher cystatin C, but not higher serum creatinine or lower eGFRCr , have an increased risk of hip fracture independent of traditional risk factors. These findings suggest that cystatin C may be a promising biomarker for identification of older adults at high risk of hip fracture.
authors.affiliation: Department of Medicine, University of Minnesota, Minneapolis, MN, USA. ensru001@umn.edu
authors.forename: Kristine E
authors.initials: KE
authors.lastname: Ensrud
authors.forename: Neeta
authors.initials: N
authors.lastname: Parimi
authors.forename: Jane A
authors.initials: JA
authors.lastname: Cauley
authors.forename: Areef
authors.initials: A
authors.lastname: Ishani
authors.forename: Yelena
authors.initials: Y
authors.lastname: Slinin
authors.forename: Teresa A
authors.initials: TA
authors.lastname: Hillier
authors.forename: Brent C
authors.initials: BC
authors.lastname: Taylor
authors.forename: Michael
authors.initials: M
authors.lastname: Steffes
authors.forename: Steven R
authors.initials: SR
authors.lastname: Cummings
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D003404:Creatinine / Q000097:blood; D055316:Cystatin C / Q000097:blood*; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006620:Hip Fractures / Q000097:blood* / Q000209:etiology / Q000503:physiopathology; D006801:Humans; D008297:Male; D015663:Osteoporosis, Postmenopausal / Q000097:blood* / Q000150:complications / Q000503:physiopathology; D012307:Risk Factors; D013997:Time Factors
chemical_list: D015415:Biomarkers; C525030:CST3 protein, human; D055316:Cystatin C; D003404:Creatinine