Association of kidney function with incident hip fracture in older adults
Association of kidney function with incident hip fracture in older adults
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DOI：
10.1681/asn.2006050546
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发表时间：
2007-01-01
影响因子：
13.6
通讯作者：
Robbins, John
中科院分区：
文献类型：
--
作者：
Fried, Linda F.;Biggs, Mary Louise;Robbins, John
肾功能障碍与骨质流失有关，ESRD患者髋部骨折的风险增加。然而，轻至中度肾脏疾病与髋部骨折的关系尚未被研究。在以社区为基础的老年人队列心血管健康研究中，研究了肾功能与髋部骨折的关系。肾功能的主要指标是血清胱抑素C，这一指标与瘦体重无关。髋部骨折采用《国际疾病分类》第九次修订住院代码进行鉴定。在1992年至1993年期间，共有4699人接受了胱抑素C检测，且在检测前未发生髋部骨折。采用Cox比例风险模型分析肾功能与髋部骨折的关系。对男性和女性分别进行了分析。平均随访7.1年后，195例女性髋部骨折，79例男性髋部骨折。较高的胱抑素C水平与女性和男性较高的骨折风险相关（风险比[HR] 1.26； 95%可信区间[CI] 1.14至1.38 / SD）（风险比[HR] 1.27； 95%可信区间[CI] 1.11至1.46）。在多变量调整后，高胱抑素C水平与女性髋部骨折显著相关（HR 1.16; 95% Cl 1.01, 1.33），而与男性无关（HR 1.14; 95% CI 0.86 - 1.52），尽管两者的关联程度相似。肾功能障碍，如胱抑素C评估，与髋部骨折风险增加有关。需要进一步的研究来评估这种关系的潜在中介因素，并评估干预措施是否可以降低这种风险。
Kidney dysfunction is associated with bone loss, and patients with ESRD have an increased risk for hip fracture. However, the association of mild to moderate kidney disease with hip fracture has not been studied previously. The association of kidney function with incident hip fracture was examined among participants in the Cardiovascular Health Study, a community-based cohort of older individuals. The primary measure of kidney function was serum cystatin C, a measure that does not depend on lean mass. Hip fractures were identified using International Classification of Diseases, Ninth Revision codes for hospitalizations. A total of 4699 individuals had cystatin C measured in 1992 to 1993 and did not have a hip fracture before cystatin C measurement. The association of kidney function with hip fracture was analyzed with Cox proportional hazards models. Analyses were conducted separately for men and women. After a mean follow-up of 7.1 yr, 195 incident hip fractures occurred in women and 79 occurred in men. Higher cystatin C levels were associated with a higher risk for fracture in women (hazard ratio [HR] 1.26; 95% confidence interval [CI] 1.14 to 1.38 per SD) and in men (HR 1.27; 95% CI 1.11 to 1.46). After multivariable adjustment, higher cystatin C levels were significantly associated with hip fracture in women (HR 1.16; 95% Cl 1.01, 1.33) but not in men (HR 1.14; 95% CI 0.86 to 1.52), although the magnitude of the association was similar. Kidney dysfunction, as assessed by cystatin C, is associated with an increased risk for hip fracture. Further studies are needed to evaluate potential mediators of this relationship and to assess whether interventions can decrease this risk.