Low hemoglobin can be a Risk factor of incident hip fracture
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In a multi-site longitudinal cohort study, decreasing hemoglobin was associated with increased hip fracture risk in men. Anemia was associated with hip fracture in men and in African American women. Decreasing hemoglobin may be a marker of progressing bone fragility, making its serial measurement useful for fracture risk stratification.

Hematopoiesis and bone health are interdependent. Anemia has been associated with risk of fracture in humans. To further elucidate this relationship, researchers hypothesized that decreasing hemoglobin could indicate defective hematopoiesis and would also predict fracture risk.

A prospective analysis from study baseline (1992) of the Cardiovascular Health Study was performed. A total of 4670 men and women, age more than 65 years, who were able to consent and not institutionalized or wheelchair bound, had hemoglobin (Hb) measured in 1992. For 4006 subjects, Hb change from 1989 to 1992 was annualized and divided into sex-specific quartiles. Incident hip fractures were verified against Medicare claims data during a median follow-up of 11.8 years.

Results:
--Nested Cox proportional-hazard models estimated association of hip fracture with anemia (men Hb less than 13 g/dL, women Hb less than 12 g/dL) and separately, greatest Hb decrease (versus others).

--Anemia was associated with increased hip fracture risk in all men (HR 1.59) and African American women (HR 3.21).

--In men, an annualized Hb loss of more than 0.36 g/dL/year was associated with a higher risk of hip fracture (HR 1.67), which was lessened by anemia at the start of fracture follow-up (HR 1.53).

In conclusion, declining Hb can be an early predictor of the risk of subsequent hip fracture in males, and may be less informative once the threshold for anaemia has been crossed. In this relationship, only African American women with anaemia had an increased risk of hip fracture, indicating a race difference.

Source: https://link.springer.com/article/10.1007/s00198-021-05873-y
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