title: Proximal Femur Volumetric Bone Mineral Density and Mortality: 13 Years of Follow-Up of the AGES-Reykjavik Study.
abstract: Bone mineral density (BMD) has been linked to mortality, but little is known about the independent contribution of each endosteal bone compartment and also the rate of bone loss to risk of mortality. We examined the relationships between (1) baseline trabecular and cortical volumetric BMD (vBMD) at the proximal femur, and (2) the rate of trabecular and cortical bone loss and all-cause mortality in older adults from the AGES-Reykjavik study. The analysis of trabecular and cortical vBMD and mortality was based on the baseline cohort of 4654 participants (aged ≥66 years) with a median follow-up of 9.4 years; the association between rate of bone loss and mortality was based on 2653 participants with bone loss data (median follow-up of 5.6 years). Analyses employed multivariable Cox-proportional models to estimate hazard ratios (HRs) with time-varying fracture status; trabecular and cortical variables were included together in all models. Adjusted for important confounders, Cox models showed that participants in the lowest quartile of trabecular vBMD had an increased risk of mortality compared to participants in other quartiles (HR = 1.12; 95% confidence interval (CI), 1.01 to 1.25); baseline cortical vBMD was not related to mortality (HR = 1.08; 95% CI, 0.97 to 1.20). After adjustment for time-dependent fracture status, results were attenuated and not statistically significant. A faster loss (quartile 1 versus quartiles 2-4) in both trabecular and cortical bone was associated with higher mortality risk (HR = 1.37 and 1.33, respectively); these associations were independent of major potential confounders including time-dependent incident fractures (HR = 1.32 and 1.34, respectively). Overall, data suggest that faster bone losses over time in both the trabecular and cortical bone compartments are associated with mortality risk and that measurements of change in bone health may be more informative than single-point measurements in explaining mortality differences in older adults. © 2017 American Society for Bone and Mineral Research.
authors.affiliation: National Institute on Aging, Intramural Research Program, Laboratory of Epidemiology and Population Sciences, Bethesda, MD, USA.
authors.forename: Elisa A
authors.initials: EA
authors.lastname: Marques
authors.affiliation: National Institute on Aging, Intramural Research Program, Laboratory of Epidemiology and Population Sciences, Bethesda, MD, USA.
authors.forename: Martine
authors.initials: M
authors.lastname: Elbejjani
authors.affiliation: Icelandic Heart Association Research Institute, Kópavogur, Iceland.|University of Iceland, Reykjavik, Iceland.
authors.forename: Vilmundur
authors.initials: V
authors.lastname: Gudnason
authors.affiliation: Icelandic Heart Association Research Institute, Kópavogur, Iceland.|University of Iceland, Reykjavik, Iceland.|Landspitali-University Hospital, Reykjavik, Iceland.
authors.forename: Gunnar
authors.initials: G
authors.lastname: Sigurdsson
authors.affiliation: Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, USA.
authors.forename: Thomas
authors.initials: T
authors.lastname: Lang
authors.affiliation: Icelandic Heart Association Research Institute, Kópavogur, Iceland.
authors.forename: Sigurdur
authors.initials: S
authors.lastname: Sigurdsson
authors.affiliation: Icelandic Heart Association Research Institute, Kópavogur, Iceland.|Centre of Public Health Sciences, University of Iceland, Reykjavik, Iceland.
authors.forename: Thor
authors.initials: T
authors.lastname: Aspelund
authors.affiliation: National Institute on Aging, Intramural Research Program, Laboratory of Epidemiology and Population Sciences, Bethesda, MD, USA.
authors.forename: Osorio
authors.initials: O
authors.lastname: Meirelles
authors.affiliation: Icelandic Heart Association Research Institute, Kópavogur, Iceland.
authors.forename: Kristin
authors.initials: K
authors.lastname: Siggeirsdottir
authors.affiliation: National Institute on Aging, Intramural Research Program, Laboratory of Epidemiology and Population Sciences, Bethesda, MD, USA.
authors.forename: Lenore
authors.initials: L
authors.lastname: Launer
authors.affiliation: Icelandic Heart Association Research Institute, Kópavogur, Iceland.
authors.forename: Gudny
authors.initials: G
authors.lastname: Eiriksdottir
authors.affiliation: National Institute on Aging, Intramural Research Program, Laboratory of Epidemiology and Population Sciences, Bethesda, MD, USA.
authors.forename: Tamara B
authors.initials: TB
authors.lastname: Harris
mesh_terms: D000368:Aged; D015519:Bone Density / Q000502:physiology*; D001862:Bone Resorption / Q000401:mortality / Q000473:pathology / Q000503:physiopathology; D000071556:Cancellous Bone / Q000473:pathology / Q000503:physiopathology; D000071538:Cortical Bone / Q000473:pathology / Q000503:physiopathology; D003710:Demography; D005260:Female; D005269:Femur / Q000473:pathology* / Q000503:physiopathology*; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D009026:Mortality; D009929:Organ Size; D012307:Risk Factors
keywords: ALL-CAUSE MORTALITY; BONE LOSS; COMPUTED TOMOGRAPHY; CORTICAL; TRABECULAR