title: Hypoalbuminemia and Osteoporosis: Reappraisal of a Controversy.
abstract: BACKGROUND
  Human studies have reported conflicting results on the association of hypoalbuminemia with osteoporosis.
  
  
  OBJECTIVE
  The aim of the study is to test the independent association between hypoalbuminemia and osteoporosis.
  
  
  METHODS
  This is a cross-sectional observation.
  
  
  METHODS
  Patients are the outpatient consecutive individuals with available clinical, laboratory, and densitometry data from 2001 to 2013 in our tertiary care academic medical center.
  
  
  METHODS
  Exposure is hypoalbuminemia defined as serum albumin less than 3.5 g/dL.
  
  
  METHODS
  Osteoporosis is defined as bone mineral density of 2.5 SD or less below the mean peak bone mass of young, healthy adults.
  
  
  RESULTS
  Overall, 21 121 patients were included. Mean of age was 61 years (SD 14). There were 4244 males (20.1%) and 1614 patients of African-American ethnicity (7.6%). There was a graded decrease in rate of osteoporosis from 28.0% (n = 33) at albumin of 3 g/dL or less to 9.3% (n = 1548) at albumin greater than 4 g/dL (P < .001) at the femoral neck and from 20.3% (n = 24) to 6.1% (n = 1011) at the total hip (P < .001). In a fully adjusted model, the odds of osteoporosis at albumin of 3 g/dL or less was 3.31-fold (95% confidence interval [CI] 2.08-5.28, P < .001) at the femoral neck, 2.98-fold (95% CI 1.76-5.01, P < .001) at the total hip, and 2.18-fold (95% CI 1.43-3.31, P < .001) at the lumbar spine as compared with albumin greater than 4 mg/dL. A similar independent association was identified with a longer-observed duration of hypoalbuminemia.
  
  
  CONCLUSIONS
  In a large population, we report an independent association of osteoporosis with lower levels of serum albumin and a longer-observed duration of hypoalbuminemia.
authors.affiliation: Division of Nephrology (F.A., S.P.), Department of Internal Medicine, Department of Nuclear Medicine/Radiology (K.K.W., R.J.A.), University of Michigan, Ann Arbor, Michigan 48109; Veterans Affairs Ann Arbor Healthcare System (K.K.W.), Ann Arbor, Michigan 48105; and Division of Radiology (B.S.), Thomas Jefferson University, Philadelphia, Pennsylvania 19107.
authors.forename: Farsad
authors.initials: F
authors.lastname: Afshinnia
authors.affiliation: Division of Nephrology (F.A., S.P.), Department of Internal Medicine, Department of Nuclear Medicine/Radiology (K.K.W., R.J.A.), University of Michigan, Ann Arbor, Michigan 48109; Veterans Affairs Ann Arbor Healthcare System (K.K.W.), Ann Arbor, Michigan 48105; and Division of Radiology (B.S.), Thomas Jefferson University, Philadelphia, Pennsylvania 19107.
authors.forename: Ka Kit
authors.initials: KK
authors.lastname: Wong
authors.affiliation: Division of Nephrology (F.A., S.P.), Department of Internal Medicine, Department of Nuclear Medicine/Radiology (K.K.W., R.J.A.), University of Michigan, Ann Arbor, Michigan 48109; Veterans Affairs Ann Arbor Healthcare System (K.K.W.), Ann Arbor, Michigan 48105; and Division of Radiology (B.S.), Thomas Jefferson University, Philadelphia, Pennsylvania 19107.
authors.forename: Baskaran
authors.initials: B
authors.lastname: Sundaram
authors.affiliation: Division of Nephrology (F.A., S.P.), Department of Internal Medicine, Department of Nuclear Medicine/Radiology (K.K.W., R.J.A.), University of Michigan, Ann Arbor, Michigan 48109; Veterans Affairs Ann Arbor Healthcare System (K.K.W.), Ann Arbor, Michigan 48105; and Division of Radiology (B.S.), Thomas Jefferson University, Philadelphia, Pennsylvania 19107.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Ackermann
authors.affiliation: Division of Nephrology (F.A., S.P.), Department of Internal Medicine, Department of Nuclear Medicine/Radiology (K.K.W., R.J.A.), University of Michigan, Ann Arbor, Michigan 48109; Veterans Affairs Ann Arbor Healthcare System (K.K.W.), Ann Arbor, Michigan 48105; and Division of Radiology (B.S.), Thomas Jefferson University, Philadelphia, Pennsylvania 19107.
authors.forename: Subramaniam
authors.initials: S
authors.lastname: Pennathur
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D044383:Black People; D015519:Bone Density; D003430:Cross-Sectional Studies; D005006:Ethnicity; D005260:Female; D006801:Humans; D034141:Hypoalbuminemia / Q000150:complications* / Q000453:epidemiology*; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D010024:Osteoporosis / Q000150:complications* / Q000453:epidemiology*; D014481:United States / Q000453:epidemiology; D044465:White People; D055815:Young Adult; D001741:Black or African American