Anemia is associated with increased risk of non-vertebral osteoporotic fractures in elderly men: the MrOS Sweden cohort

Hallgerdur Lind Kristjansdottir; Dan Mellström; Peter Johansson; Magnus Karlsson; Liesbeth Vandenput; Mattias Lorentzon; Hans Herlitz; Claes Ohlsson; Ulf H Lerner; Catharina Lewerin

doi:10.1007/s11657-022-01130-9

Anemia is associated with increased risk of non-vertebral osteoporotic fractures in elderly men: the MrOS Sweden cohort

Arch Osteoporos. 2022 Jun 23;17(1):85. doi: 10.1007/s11657-022-01130-9.

Authors

Hallgerdur Lind Kristjansdottir¹, Dan Mellström^{2

3}, Peter Johansson⁴, Magnus Karlsson⁵, Liesbeth Vandenput^{2

6}, Mattias Lorentzon^{2

3

6}, Hans Herlitz⁷, Claes Ohlsson^{2

8}, Ulf H Lerner², Catharina Lewerin⁴

Affiliations

¹ Section of Hematology and Coagulation at the Sahlgrenska University Hospital and Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden. hallgerdur.lind@gmail.com.
² Center for Bone and Arthritis Research (CBAR) at the Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden.
³ Department of Geriatric Medicine, Internal Medicine, Institute of Medicine, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden.
⁴ Section of Hematology and Coagulation at the Sahlgrenska University Hospital and Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden.
⁵ Clinical and Molecular Osteoporosis Research Unit, Department of Clinical Sciences and Orthopedics, Skåne University Hospital (SUS), Lund University, Malmö, Sweden.
⁶ Mary MacKillop, Institute for Health Research, Australian Catholic University, Melbourne, VIC, Australia.
⁷ Department of Molecular and Clinical Medicine/Nephrology, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
⁸ Department of Drug Treatment, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden.

Abstract

This study includes 1005 men from the Gothenburg part of the Osteoporotic Fracture in Men Study (MrOS). Included are 66 men with anemia (hemoglobin < 130 g/L). The follow-up time was up to 16 years, and the main results are that anemia is associated with all fractures and non-vertebral osteoporotic fractures.

Introduction: Anemia and osteoporotic fractures are conditions that are associated with increased morbidity and mortality. Clinical studies have suggested that anemia can be used as a predictor of future osteoporotic fractures.

Method: Men from the Osteoporotic Fractures in Men Study (MrOS) Sweden, Gothenburg, with available hemoglobin (Hb) values (n = 1005, median age 75.3 years (SD 3.2)), were included in the current analyses. Of these, 66 suffered from anemia, defined as Hb < 130 g/L. Median follow-up time for fracture was 10.1 years and the longest follow-up time was 16.1 years.

Results: Men with anemia had, at baseline, experienced more falls and had a higher prevalence of diabetes, cancer, prostate cancer, hypertension, and stroke. Anemia was not statistically significantly associated with bone mineral density (BMD). Men with anemia had higher serum levels of fibroblast growth factor 23 (iFGF23) (p < 0.001) and phosphate (p = 0.001) and lower serum levels of testosterone (p < 0.001) and estradiol (p < 0.001). Moreover, men with anemia had an increased risk of any fracture (hazard ratio (HR) 1.97, 95% CI 1.28-3.02) and non-vertebral osteoporotic fracture (HR 2.15, 95% CI 1.18-3.93), after adjustment for age and total hip BMD, in 10 years. The risk for any fracture was increased in 10 and 16 years independently of falls, comorbidities, inflammation, and sex hormones. The age-adjusted risk of hip fracture was increased in men with anemia (HR 2.32, 95% CI 1.06-5.12), in 10 years, although this was no longer statistically significant after further adjustment for total hip BMD.

Conclusions: Anemia is associated with an increased risk for any fracture and non-vertebral osteoporotic fracture in elderly men with a long follow-up time. The cause is probably multifactorial and our results support that anemia can be used as a predictor for future fracture.

Keywords: Anemia; Elderly men; Fractures; iFGF23.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Aged
Anemia* / epidemiology
Bone Density
Hemoglobins
Humans
Incidence
Male
Osteoporotic Fractures* / etiology
Risk Factors
Sweden / epidemiology

Substances

Hemoglobins