title: Association of Fetuin-A With Incident Fractures in Community-Dwelling Older Adults: The Cardiovascular Health Study.
abstract: Fetuin-A, a serum protein that regulates calcium mineralization, has been associated with bone mineral density (BMD) in several cross-sectional human studies, suggesting a possible beneficial effect on clinically important measures of bone health. Fetuin-A and incidence of subsequent fracture was assessed in 4714 men and women ≥65 years of age. Proportional hazards models were used to estimate risk of incident hip (hospital discharge ICD-9 codes) and composite fracture (hip, pelvis, humerus, or proximal forearm; hospital discharge ICD-9 codes and Medicare claims data). A total of 576 participants had an incident hip fracture (median follow-up 11.2 years) and 768 had an incident composite fracture (median follow-up 6.9 years). In unadjusted analyses, there was no association between fetuin-A (per SD increase) and risk of hip fracture (hazard ratio [HR], 0.96; 95% CI, 0.88 to 1.05) or composite fracture (HR, 0.99; 95% CI, 0.92 to 1.06). Results were not significantly changed after adjustment for potential confounding variables. Analyses modeling fetuin-A in quartiles or within a subset with available BMD measures also showed no statistically significant association with risk of hip or composite fracture. Though fetuin-A was positively associated with areal BMD in partially adjusted models (total hip: β, 0.013 g/cm(2) ; 95% CI, 0.005 to 0.021; femoral neck: β, 0.011 g/cm(2) ; 95% CI, 0.004 to 0.018; and lumbar spine: β, 0.007 g/cm(2) ; 95% CI, 0.001 to 0.028), these associations were no longer significant after further adjustment for BMI and in final multivariate models. In this large sample of community-dwelling older adults, a small positive association between fetuin-A and areal BMD appeared attributable to confounding variables and we found no evidence of an association between fetuin-A and risk of clinical fracture.
authors: Geriatric Research Education & Clinical Center, Veterans Affairs Health Care System, Minneapolis, MN, USA.|Center for Chronic Disease Outcomes Research, Veterans Affairs Health Care System, Minneapolis, MN, USA.|Department of Medicine, University of Minnesota, Minneapolis, MN, USA.|Division of Epidemiology & Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA.
authors: Howard A
authors: HA
authors: Fink
authors: Department of Biostatistics, University of Washington, Seattle, WA, USA.
authors: Petra
authors: P
authors: Bůžková
authors: Division of Nephrology, Tufts Medical Center, Boston, MA, USA.
authors: Pranav S
authors: PS
authors: Garimella
authors: Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Boston, MA, USA.
authors: Kenneth J
authors: KJ
authors: Mukamal
authors: Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA.
authors: Jane A
authors: JA
authors: Cauley
authors: Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, USA.|Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA.
authors: Jorge R
authors: JR
authors: Kizer
authors: Division of Endocrinology, Kaiser Permanente of Georgia, Atlanta, GA, USA.|Division of Endocrinology, Emory University School of Medicine, Atlanta, GA, USA.
authors: Joshua I
authors: JI
authors: Barzilay
authors: Division of Renal Diseases and Hypertension, University of Colorado Anschutz Medical Center, Aurora, CO, USA.
authors: Diana I
authors: DI
authors: Jalal
authors: Nephrology Section, Veterans Affairs Health Care System, San Diego, CA, USA.|Division of Nephrology-Hypertension, University of California San Diego, San Diego, CA, USA.
authors: Joachim H
authors: JH
authors: Ix
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015519:Bone Density; D003430:Cross-Sectional Studies; D005260:Female; D005500:Follow-Up Studies; D050723:Fractures, Bone / Q000097:blood / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D008297:Male; D008954:Models, Biological; D060749:alpha-2-HS-Glycoprotein / Q000378:metabolism*
chemical_list: C556354:AHSG protein, human; D060749:alpha-2-HS-Glycoprotein
keywords: ALPHA-2-HS-GLYCOPROTEIN; FETUINS; FRACTURES; GERIATRICS; HIP FRACTURES; RISK FACTORS