This paper was presented at the 29th Annual Meeting of the American Society for Bone and Mineral Research, Honolulu, Hawaii, September 2007.
Cystatin-C, Renal Function, and Incidence of Hip Fracture in Postmenopausal Women
Article first published online: 24 JUL 2008
© 2008, Copyright the Authors. Journal compilation © 2008, The American Geriatrics Society
Journal of the American Geriatrics Society
Volume 56, Issue 8, pages 1434–1441, August 2008
How to Cite
LaCroix, A. Z., Lee, J. S., Wu, L., Cauley, J. A., Shlipak, M. G., Ott, S. M., Robbins, J., Curb, J. D., Leboff, M., Bauer, D. C., Jackson, R. D., Kooperberg, C. L. and Cummings, S. R. (2008), Cystatin-C, Renal Function, and Incidence of Hip Fracture in Postmenopausal Women. Journal of the American Geriatrics Society, 56: 1434–1441. doi: 10.1111/j.1532-5415.2008.01807.x
- Issue published online: 2 SEP 2008
- Article first published online: 24 JUL 2008
- chronic kidney disease;
- hip fracture;
- renal function
OBJECTIVES: To evaluate the association between chronic kidney disease and incident hip fracture using serum cystatin-C as a biomarker of renal function calculated without reference to muscle mass.
DESIGN: Case-control study nested within a prospective study.
SETTING: The Women's Health Initiative Observational Study conducted at 40 U.S. clinical centers.
PARTICIPANTS: From 93,676 women aged 50 to 79 followed for an average of 7 years, 397 incident hip fracture cases and 397 matched controls were studied.
MEASUREMENTS: Cystatin-C levels were measured on baseline serum using a particle-enhanced immunonepholometric assay. Estimated glomerular filtration rates (eGFRcys-c) were calculated using a validated equation and categorized into three groups (≥90.0 mL/min per 1.73 m2, 60.0–89.9 mL/min per 1.73 m2, and <60.0 mL/min per 1.73 m2 indicating chronic kidney disease Stages 3 to 4).
RESULTS: The odds ratio (OR) for hip fracture was 2.50 (95% confidence interval (CI)=1.32–4.72) for eGFRcys-c less than 60 mL/min per 1.73 m2 compared with Stages 0 to 1, after adjustment for body mass, parental hip fracture, smoking, alcohol consumption, and physical function. No association was observed for eGFRcys-c of 60 to 90 mL/min per 1.73 m2 (OR=1.04, 95% CI=0.66–1.64). Additional adjustment for poor health status, hemoglobin, serum 25-hydroxy vitamin D, and bone metabolism markers did not affect these associations. Adjustment for plasma homocysteine reduced the OR for eGFRcys-c less than 60 mL/min per 1.73 m2 to 1.83 (95% CI=0.93–3.61).
CONCLUSION: Women with eGFRcys-c levels less than 60 mL/min per 1.73 m2 have a substantially greater risk of hip fracture. Effects of renal function on homocysteine levels may partially mediate, or accompany, this association.