title: Bone mineral density and chronic lung disease mortality: the rotterdam study.
abstract: BACKGROUND
  Low bone mineral density (BMD) has been associated with increased all-cause mortality. Cause-specific mortality studies have been controversial.
  
  
  OBJECTIVE
  The aim of the study was to investigate associations between BMD and all-cause mortality and in-depth cause-specific mortality.
  
  
  METHODS
  We studied two cohorts from the prospective Rotterdam Study (RS), initiated in 1990 (RS-I) and 2000 (RS-II) with average follow-up of 17.1 (RS-I) and 10.2 (RS-II) years until January 2011. Baseline femoral neck BMD was analyzed in SD values. Deaths were classified according to International Classification of Diseases into seven groups: cardiovascular diseases, cancer, infections, external, dementia, chronic lung diseases, and other causes. Gender-stratified Cox and competing-risks models were adjusted for age, body mass index, and smoking.
  
  
  METHODS
  The study included 5779 subjects from RS-I and 2055 from RS-II.
  
  
  METHODS
  We measured all-cause and cause-specific mortality.
  
  
  RESULTS
  A significant inverse association between BMD and all-cause mortality was found in males [expressed as hazard ratio (95% confidence interval)]: RS-I, 1.07 (1.01-1.13), P = .020; RS-II, 1.31 (1.12-1.55), P = .001); but it was not found in females: RS-I, 1.05 (0.99-1.11), P = .098; RS-II, 0.91 (0.74-1.12), P = .362. An inverse association with chronic lung disease mortality was found in males [RS-I, 1.75 (1.34-2.29), P < .001; RS-II, 2.15 (1.05-4.42), P = .037] and in RS-I in females [1.72 (1.16-2.57); P = .008], persisting after multiple adjustments and excluding prevalent chronic obstructive pulmonary disease. A positive association between BMD and cancer mortality was detected in females in RS-I [0.89 (0.80-0.99); P = .043]. No association was found with cardiovascular mortality.
  
  
  CONCLUSIONS
  BMD is inversely associated with mortality. The strong association of BMD with chronic lung disease mortality is a novel finding that needs further analysis to clarify underlying mechanisms.
authors.affiliation: Departments of Internal Medicine (N.C.-O., M.C.C.-B., L.O., B.H.C.S., H.T., F.R., A.G.U., M.C.Z.) and Epidemiology (M.C.C.-B., O.H.F., B.H.C.S., G.G.B., L.L., A.H., F.R., A.G.U., M.C.Z.), Erasmus MC, 3000 CA Rotterdam, The Netherlands; Department of Respiratory Medicine (G.G.B., L.L.), Ghent University Hospital, B-9000 Ghent, Belgium; Departments of Respiratory Medicine (G.G.B.) and Psychiatric Epidemiology (H.T.), Erasmus MC, 3000 CA Rotterdam, The Netherlands; and Netherlands Genomics Initiative-Sponsored Netherlands Consortium for Healthy Ageing (M.C.C.-B., L.O., O.H.F., A.H., F.R., A.G.U., M.C.Z.), 2300 RC Leiden, The Netherlands.
authors.forename: Natalia
authors.initials: N
authors.lastname: Campos-Obando
authors.forename: Martha C
authors.initials: MC
authors.lastname: Castano-Betancourt
authors.forename: Ling
authors.initials: L
authors.lastname: Oei
authors.forename: Oscar H
authors.initials: OH
authors.lastname: Franco
authors.forename: Bruno H Ch
authors.initials: BH
authors.lastname: Stricker
authors.forename: Guy G
authors.initials: GG
authors.lastname: Brusselle
authors.forename: Lies
authors.initials: L
authors.lastname: Lahousse
authors.forename: Albert
authors.initials: A
authors.lastname: Hofman
authors.forename: Henning
authors.initials: H
authors.lastname: Tiemeier
authors.forename: Fernando
authors.initials: F
authors.lastname: Rivadeneira
authors.forename: André G
authors.initials: AG
authors.lastname: Uitterlinden
authors.forename: M Carola
authors.initials: MC
authors.lastname: Zillikens
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015519:Bone Density / Q000502:physiology*; D002318:Cardiovascular Diseases / Q000401:mortality* / Q000503:physiopathology; D003704:Dementia / Q000401:mortality* / Q000503:physiopathology; D005260:Female; D006801:Humans; D008171:Lung Diseases / Q000401:mortality* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000401:mortality* / Q000503:physiopathology; D011446:Prospective Studies; D012307:Risk Factors