title: Association of Increased Urinary Albumin With Risk of Incident Clinical Fracture and Rate of Hip Bone Loss: the Osteoporotic Fractures in Men Study.
abstract: Prior studies suggest that increased urine albumin is associated with a heightened fracture risk in women, but results in men are unclear. We used data from Osteoporotic Fractures in Men (MrOS), a prospective cohort study of community-dwelling men aged ≥65 years, to evaluate the association of increased urine albumin with subsequent fractures and annualized rate of hip bone loss. We calculated albumin/creatinine ratio (ACR) from urine collected at the 2003-2005 visit. Subsequent clinical fractures were ascertained from triannual questionnaires and centrally adjudicated by review of radiographic reports. Total hip BMD was measured by DXA at the 2003-2005 visit and again an average of 3.5 years later. We estimated risk of incident clinical fracture using Cox proportional hazards models, and annualized BMD change using ANCOVA. Of 2982 men with calculable ACR, 9.4% had ACR ≥30 mg/g (albuminuria) and 1.0% had ACR ≥300 mg/g (macroalbuminuria). During a mean of 8.7 years of follow-up, 20.0% of men had an incident clinical fracture. In multivariate-adjusted models, neither higher ACR quintile (p for trend 0.75) nor albuminuria (HR versus no albuminuria, 0.89; 95% CI, 0.65 to 1.20) was associated with increased risk of incident clinical fracture. Increased urine albumin had a borderline significant, multivariate-adjusted, positive association with rate of total hip bone loss when modeled in ACR quintiles (p = 0.06), but not when modeled as albuminuria versus no albuminuria. Macroalbuminuria was associated with a higher rate of annualized hip bone loss compared to no albuminuria (-1.8% more annualized loss than in men with ACR <30 mg/g; p < 0.001), but the limited prevalence of macroalbuminuria precluded reliable estimates of its fracture associations. In these community-dwelling older men, we found no association between urine albumin levels and risk of incident clinical fracture, but found a borderline significant, positive association with rate of hip bone loss. © 2016 American Society for Bone and Mineral Research.
authors.affiliation: 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 and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA.
authors.forename: Howard A
authors.initials: HA
authors.lastname: Fink
authors.affiliation: Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA.
authors.forename: Tien N
authors.initials: TN
authors.lastname: Vo
authors.affiliation: Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA.
authors.forename: Lisa
authors.initials: L
authors.lastname: Langsetmo
authors.affiliation: Division of Endocrinology, Kaiser Permanente of Georgia, Atlanta, GA, USA.|Division of Endocrinology, Emory University School of Medicine, Atlanta, GA, USA.
authors.forename: Joshua I
authors.initials: JI
authors.lastname: Barzilay
authors.affiliation: Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA, USA.
authors.forename: Jane A
authors.initials: JA
authors.lastname: Cauley
authors.affiliation: Park Nicollet Institute, Minneapolis, MN, USA.|Division of Health Policy and Management, University of Minnesota, Minneapolis, MN, USA.
authors.forename: John T
authors.initials: JT
authors.lastname: Schousboe
authors.affiliation: Bone and Mineral Unit, Oregon Health & Science University, Portland, OR, USA.
authors.forename: Eric S
authors.initials: ES
authors.lastname: Orwoll
authors.affiliation: Department of Medicine (Nephrology), College of Public Health and Health Professions & College of Medicine, University of Florida, Gainesville, FL, USA.
authors.forename: Muna T
authors.initials: MT
authors.lastname: Canales
authors.affiliation: Department of Medicine, University of Minnesota, Minneapolis, MN, USA.
authors.forename: Areef
authors.initials: A
authors.lastname: Ishani
authors.affiliation: Division of Rheumatology, Allergy and Clinical Immunology, Department of Medicine, University of California, Davis, Davis, CA, USA.
authors.forename: Nancy E
authors.initials: NE
authors.lastname: Lane
authors.affiliation: 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 and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA.
authors.forename: Kristine E
authors.initials: KE
authors.lastname: Ensrud
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000419:Albuminuria / Q000453:epidemiology*; D050723:Fractures, Bone / Q000453:epidemiology* / Q000652:urine*; D006801:Humans; D015994:Incidence; D008297:Male; D010024:Osteoporosis / Q000453:epidemiology* / Q000652:urine*; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors
keywords: ALBUMINURIA; FRACTURE; MALE; OSTEOPOROSIS