title: Soluble CD14 and fracture risk.
abstract: Soluble CD14 (sCD14) is an inflammatory marker associated with osteoclasts. Using Cox proportional hazards models, we found a positive association between plasma levels of sCD14 and risk of incident fracture among participants in the Cardiovascular Health Study. sCD14 may be useful in identifying those at risk for fracture.
  
  
  BACKGROUND
  Soluble CD14, a proinflammatory cytokine, is primarily derived from macrophages/monocytes that can differentiate into osteoclasts. The purpose of this study was to examine the relationship between sCD14 levels and osteoporotic fractures.
  
  
  METHODS
  In the Cardiovascular Health Study, 5462 men and women had sCD14 levels measured at baseline. Incident hip fractures (median follow-up time 12.5 years) and incident composite fractures (defined as the first hip, pelvis, humerus, or distal radius fracture, median follow-up 8.6 years) were identified from hospital discharge summaries and/or Medicare claims data. Cox proportional hazards models were used to model the association between sCD14 levels and time to incident hip or composite fracture, overall and as a function of race and gender.
  
  
  RESULTS
  In unadjusted models, there was a positive association between sCD14 levels (per 1 standard deviation increase, i.e., 361.6 ng/mL) and incident hip (HR, 1.26; 95 % CI, 1.17, 1.36) and composite (HR, 1.20; 95 % CI, 1.12, 1.28) fractures. When models were fully adjusted for demographics, lifestyle factors, and medication use, these associations were no longer significant. However, in whites, the association of sCD14 levels with hip fractures remained significant in fully adjusted models (HR, 1.11; 95 % CI, 1.01-1.23). Associations of sCD14 levels with hip and composite fracture did not differ between men and women.
  
  
  CONCLUSIONS
  In this large cohort of community-dwelling older adults, higher sCD14 levels were associated with an increased risk of incident hip fractures in whites.
authors.affiliation: Department of Medicine, Medical College of Georgia, 1120 15th Street, BI 5070, Augusta, GA, 30912, USA. mbethel@gru.edu.|Subspecialty Service, Charlie Norwood VA Medical Center, Augusta, GA, USA. mbethel@gru.edu.
authors.forename: M
authors.initials: M
authors.lastname: Bethel
authors.affiliation: Department of Biostatistics, University of Washington, Seattle, WA, USA.
authors.forename: P
authors.initials: P
authors.lastname: Bůžková
authors.affiliation: Geriatric Research Education and Clinical Center, and Center for Chronic Disease Outcomes Research, Veterans Affairs Health Care System, Minneapolis, MN, USA.|Department of Medicine, and Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN, USA.
authors.forename: H A
authors.initials: HA
authors.lastname: Fink
authors.affiliation: Division of General Medicine, Department of Internal Medicine, University of California, Davis, Sacramento, CA, USA.
authors.forename: J A
authors.initials: JA
authors.lastname: Robbins
authors.affiliation: Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA.
authors.forename: J A
authors.initials: JA
authors.lastname: Cauley
authors.affiliation: Divisions of Endocrinology, Clinical Nutrition and Vascular Medicine, Department of Internal Medicine, University of California, Davis, Sacramento, CA, USA.
authors.forename: J
authors.initials: J
authors.lastname: Lee
authors.affiliation: Division of Endocrinology, Kaiser Permanente of Georgia and the Division of Endocrinology, Emory University School of Medicine, Atlanta, GA, USA.
authors.forename: J I
authors.initials: JI
authors.lastname: Barzilay
authors.affiliation: Division of Renal Diseases and Hypertension, University of Colorado Anschutz Medical Center, Aurora, CO, USA.
authors.forename: D I
authors.initials: DI
authors.lastname: Jalal
authors.affiliation: Department of Medicine, Medical College of Georgia, 1120 15th Street, BI 5070, Augusta, GA, 30912, USA.|Subspecialty Service, Charlie Norwood VA Medical Center, Augusta, GA, USA.
authors.forename: L D
authors.initials: LD
authors.lastname: Carbone
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D005260:Female; D006620:Hip Fractures / Q000097:blood / Q000453:epidemiology; D006801:Humans; D018836:Inflammation Mediators / Q000097:blood*; D053208:Kaplan-Meier Estimate; D018950:Lipopolysaccharide Receptors / Q000097:blood*; D008137:Longitudinal Studies; D008297:Male; D058866:Osteoporotic Fractures / Q000097:blood* / Q000453:epidemiology; D018570:Risk Assessment / Q000379:methods; D012995:Solubility; D014481:United States / Q000453:epidemiology
chemical_list: D015415:Biomarkers; D018836:Inflammation Mediators; D018950:Lipopolysaccharide Receptors
keywords: Epidemiology; Fracture; Inflammatory markers; Osteoporosis