title: Association of Hypoalbuminemia With Osteoporosis: Analysis of the National Health and Nutrition Examination Survey.
abstract: BACKGROUND
  The association of hypoalbuminemia with osteoporosis in human studies is controversial.
  
  
  OBJECTIVE
  We tested the independent association between hypoalbuminemia and osteoporosis in a national dataset.
  
  
  METHODS
  This is a cross-sectional observation.
  
  
  METHODS
  Participants are individuals selected from the National Health and Nutrition Examination Survey (NHANES) with available clinical, laboratory, and densitometry data from the 2005-2010 and 2013-2014 cycles.
  
  
  METHODS
  Exposure is hypoalbuminemia defined as serum albumin <3.5 g/dL.
  
  
  METHODS
  Osteoporosis is defined as bone mineral density of ≤2.5 SD below the mean peak bone mass of young, healthy adults. Analysis took into account the hidden variance and the weighting methodology pertinent to analysis of NHANES.
  
  
  RESULTS
  Overall, 15 539 individuals were included. The mean age was 48.6 years (SE = 0.27). Fifty percent of the individuals were male, and 10.2% were of the black race. There was a graded decrease in the rate of osteoporosis from 15.2% at albumin <3.5 g/dL to 2.6% at albumin >4 g/dL (P = .007) at the femoral neck and from 11.0 to 1.4% at total femur (P = .009). In a fully adjusted model, the odds of osteoporosis with hypoalbuminemia were 5.37-fold (95% confidence interval [CI], 1.43 to 20.20; P = .014) at the femoral neck, 12.46-fold (95% CI, 3.24 to 48.01; P < .001) at total femur, and 4.59-fold (95% CI, 1.49 to 14.16; P = .025) at the lumbar spine higher as compared to albumin >4 mg/dL.
  
  
  CONCLUSIONS
  In the NHANES dataset, we report an independent association of osteoporosis with hypoalbuminemia at different anatomical sites.
authors.affiliation: Division of Nephrology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan 48109.
authors.forename: Farsad
authors.initials: F
authors.lastname: Afshinnia
authors.affiliation: Division of Nephrology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan 48109.
authors.forename: Subramaniam
authors.initials: S
authors.lastname: Pennathur
mesh_terms: D015519:Bone Density / Q000502:physiology*; D015897:Comorbidity; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D034141:Hypoalbuminemia / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D009749:Nutrition Surveys; D010024:Osteoporosis / Q000453:epidemiology*; D015995:Prevalence