03088nas a2200421 4500008004100000022001400041245010300055210006900158260001300227300001400240490000700254520196800261653000902229653002202238653001602260653001702276653001102293653002202304653001802326653001402344653001102358653001402369653002602383653000902409653002702418653001702445653001602462653001802478100001902496700001802515700001202533700001802545700001502563700001902578700001502597700001802612856003602630 2013 eng d a1433-296500aAlbuminuria is associated with hip fracture risk in older adults: the cardiovascular health study.0 aAlbuminuria is associated with hip fracture risk in older adults c2013 Dec a2993-30000 v243 a

UNLABELLED: The microcirculation plays an important role in bone health. Here, we examine whether albuminuria, a marker of renal microvascular disease, is associated with the risk of hip fracture in older adults (age, 78 years). We find a small independent association in women but not in men.

INTRODUCTION: The microvascular circulation plays an important role in bone physiology. Two studies of middle-aged adults have found that albuminuria (>30 mg albumin/g creatinine), a disorder of the renal microvasculature, is associated with fracture risk. Here, we examine whether albuminuria is related to hip fracture risk and reduced hip bone mineral density (BMD) in older adults with a mean age of 78 years.

METHODS: From the Cardiovascular Health Study (41 % male), 3,110 adults with albuminuria testing were followed up for incident hip fracture for up to 9.5 years. BMD was performed in a subset of 1,208 participants.

RESULTS: There were 313 hip fractures during follow-up (7.7 % of men; 11.7 % of women). The incidence rate for men, with and without albuminuria, was 1.43 and 0.93/100 person-years of follow-up (p = 0.02); for women, 1.84 and 1.33 (p = 0.04). After adjustment for osteoporosis-related factors, frailty and falling, a doubling of albuminuria was significantly associated with hip fracture risk in women (hazard ratio, 1.12, 95 % CI, 1.001-1.25), but not in men. In the subcohort with BMD measurement, increased urine albumin levels were significantly associated with decreased total hip BMD in men (-0.009 g calcium/cm(2) (-0.017, -0.001); p = 0.04), but not in women.

CONCLUSIONS: In older women, albuminuria is associated with a small, but statistically significant, increased risk of hip fracture independent of other explanatory factors. No such risk appears to be present in men, although their total hip BMD is lower in association with albuminuria.

10aAged10aAged, 80 and over10aAlbuminuria10aBone Density10aFemale10aFollow-Up Studies10aHip Fractures10aHip Joint10aHumans10aIncidence10aKaplan-Meier Estimate10aMale10aOsteoporotic Fractures10aRisk Factors10aSex Factors10aUnited States1 aBarzilay, J, I1 aBůžková, P1 aChen, Z1 ade Boer, I, H1 aCarbone, L1 aRassouli, N, N1 aFink, H, A1 aRobbins, J, A uhttps://chs-nhlbi.org/node/605902527nas a2200277 4500008004100000022001400041245009400055210006900149260001300218300001200231490000700243520176400250100001802014700002002032700001802052700001402070700001602084700001802100700001502118700001702133700001802150700001502168700001202183700001802195856003602213 2017 eng d a1433-296500aIncident atrial fibrillation and the risk of fracture in the cardiovascular health study.0 aIncident atrial fibrillation and the risk of fracture in the car c2017 Feb a719-7250 v283 a

In this prospective cohort of 4462 older adults, incident atrial fibrillation (AF) was not statistically significantly associated with subsequent risk of incident fracture.

INTRODUCTION: AF is associated with stroke, heart failure, dementia, and death, but its association with fracture is unknown. Therefore, we examined the association of incident AF with the risk of subsequent fracture in the Cardiovascular Health Study (CHS) cohort.

METHODS: Of the CHS participants aged ≥65 years, 4462 were followed between 1991 and 2009, mean follow-up 8.8 years. Incident AF was identified by annual study electrocardiogram (ECG), hospital discharge diagnosis codes, or Medicare claims. Fractures of the hip, distal forearm, humerus, or pelvis were identified using hospital discharge diagnosis codes or Medicare claims. We used Cox proportional hazard models to estimate hazard ratios (HRs) and 95 % confidence intervals (CIs) for the association between incident AF (time-varying) and the risk of subsequent fracture. We also evaluated whether AF was associated with risk of sustaining a fall.

RESULTS: Crude incident fracture rate was 22.9 per 1000 person-years in participants with AF and 17.7 per 1000 person-years in participants without AF. Individuals with incident AF were not at significantly higher risk of hip fracture (adjusted HR = 1.09, 95 % CI 0.83-1.42) or fracture at any selected site (adjusted HR = 0.97, 95 % CI 0.77-1.22) or risk of sustaining a fall (adjusted HR = 1.00, 95 % CI = 0.87-1.16) compared with those without AF.

CONCLUSION: In this cohort of older, community-dwelling adults, incident AF was not shown to be associated with falls or hip or other fractures.

1 aWallace, E, R1 aSiscovick, D, S1 aSitlani, C, M1 aDublin, S1 aMitchell, P1 aRobbins, J, A1 aFink, H, A1 aCauley, J, A1 aBůžková, P1 aCarbone, L1 aChen, Z1 aHeckbert, S R uhttps://chs-nhlbi.org/node/7365