title: Ratio of urine albumin to creatinine attenuates the association of dementia with hip fracture risk.
abstract: BACKGROUND
  Microvascular disease is a leading cause of cognitive impairment. Approximately 50% of people with a hip fracture have cognitive impairment.
  
  
  OBJECTIVE
  We tested the hypothesis that microvascular diseases of the brain (lacunar infarcts and white matter disease [WMD]), kidney (albuminuria [≥ 30 mg/g creatinine] and albumin creatinine ratio [ACR]), and eye (retinal vascular disorders) attenuate the association of cognitive impairment with hip fracture risk.
  
  
  METHODS
  The Cardiovascular Health Cognition Study.
  
  
  METHODS
  Three thousand, one-hundred six participants (mean age, ∼ 79 y; 8.84 y median follow-up) with cognitive testing. Subsets received ACR testing (n=2389), brain magnetic resonance imaging scans (n = 2094), and retinal photography (n = 1098).
  
  
  METHODS
  Incident hip fracture.
  
  
  RESULTS
  There were 488 participants (16%) with mild cognitive impairment (MCI) and 564 (18%) with dementia. There were 337 incident hip fractures, of which 19% occurred in participants with MCI and 26% in participants with dementia. Adjusted hazard ratios (HR) and 95% confidence interval for hip fracture in participants with MCI were 2.45 (1.67-3.61) and for dementia 2.35 (1.57-3.52). With doubling of ACR, the HR for fracture was attenuated in participants with dementia compared with participants with normal cognition [interaction HR 0.70 (0.55-0.91)]. No such effect was found in participants with MCI. Albuminuria, lacunar infarcts, WMD, and retinal vascular disease (RVD) did not modify the association of dementia or MCI with hip fracture risk.
  
  
  CONCLUSIONS
  ACR attenuates part of the risk of hip fracture in people with dementia, suggesting that these disorders share a common pathogenesis.
authors.affiliation: Department of Biostatistics (P.B.), University of Washington, Seattle, Washington 98115; Division of Endocrinology, Kaiser Permanente of Georgia and the Division of Endocrinology (J.I.B.), Emory University School of Medicine, Atlanta, Georgia 30096; Geriatric Research Education & Clinical Center (H.A.F.), Veterans Affair Medical Center, Minneapolis, Minnesota 55417; Department of Medicine (J.A.R.), University of California, Davis, Sacramento, California; Department of Epidemiology (J.A.C.), Graduate School of Public Health, University of Pittsburgh, Pittsburgh 15261, Pennsylvania; and Department of Epidemiology (A.L.F.), University of Washington, Seattle, Washington 98115.
authors.forename: Petra
authors.initials: P
authors.lastname: Bůžková
authors.forename: Joshua I
authors.initials: JI
authors.lastname: Barzilay
authors.forename: Howard A
authors.initials: HA
authors.lastname: Fink
authors.forename: John A
authors.initials: JA
authors.lastname: Robbins
authors.forename: Jane A
authors.initials: JA
authors.lastname: Cauley
authors.forename: Annette L
authors.initials: AL
authors.lastname: Fitzpatrick
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000419:Albuminuria / Q000150:complications / Q000652:urine*; D060825:Cognitive Dysfunction / Q000453:epidemiology / Q000209:etiology* / Q000652:urine; D003404:Creatinine / Q000652:urine*; D003704:Dementia / Q000453:epidemiology / Q000209:etiology* / Q000652:urine; D005260:Female; D006620:Hip Fractures / Q000453:epidemiology / Q000209:etiology* / Q000652:urine; D006801:Humans; D015994:Incidence; D008279:Magnetic Resonance Imaging; D008297:Male; D009483:Neuropsychological Tests; D011446:Prospective Studies; D012306:Risk
chemical_list: D003404:Creatinine