Document Detail


C-reactive protein, bone strength, and nine-year fracture risk: data from the Study of Women's Health Across the Nation (SWAN).
MedLine Citation:
PMID:  23456822     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Higher levels of C-reactive protein (CRP), an inflammatory marker, are associated with increased fracture risk, although previous studies on CRP and bone mineral density (BMD) have yielded conflicting results. We aimed to test the hypotheses that composite indices of femoral neck strength relative to load, which are inversely associated with fracture risk, would also be inversely associated with CRP, and would explain part of the association between CRP and fracture risk. We analyzed data from a multisite, multiethnic prospective cohort of 1872 community-dwelling women, premenopausal or early perimenopausal at baseline. Femoral neck composite strength indices in three failure modes were calculated using dual-energy X-ray absorptiometry (DXA)-derived femoral neck width (FNW), femoral neck axis length (FNAL), femoral neck BMD and body size at baseline, as BMD*FNW/weight for compression strength, BMD*(FNW)(2) /(FNAL*weight) for bending strength, and BMD*FNW*FNAL/(height*weight) for impact strength. Incident nondigital, noncraniofacial fractures were ascertained annually over a median follow-up of 9 years. In analyses adjusted for age, race/ethnicity, diabetes, menopause transition stage, body mass index, smoking, alcohol use, physical activity, medications, prior fracture, and study site, CRP was associated inversely with each composite strength index (0.035-0.041 SD decrement per doubling of CRP, all p < 0.001), but not associated with femoral neck or lumbar spine BMD. During the follow-up, 194 women (10.4%) had fractures. In Cox proportional hazards analyses, fracture hazard increased linearly with loge (CRP), only for CRP levels ≥ 3 mg/L. Addition of femoral neck or lumbar spine BMD to the model did not attenuate the CRP-fracture association. However, addition of any of the composite strength indices attenuated the CRP-fracture association and made it statistically nonsignificant. We conclude that fracture risk increases with increasing CRP, only above the threshold of 3 mg/L. Unlike BMD, composite strength indices are inversely related to CRP levels, and partially explain the increased fracture risk associated with inflammation.
Authors:
Shinya Ishii; Jane A Cauley; Gail A Greendale; Carolyn J Crandall; Michelle E Danielson; Yasuyoshi Ouchi; Arun S Karlamangla
Publication Detail:
Type:  Clinical Trial; Journal Article; Multicenter Study; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't; Research Support, U.S. Gov't, Non-P.H.S.    
Journal Detail:
Title:  Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research     Volume:  28     ISSN:  1523-4681     ISO Abbreviation:  J. Bone Miner. Res.     Publication Date:  2013 Jul 
Date Detail:
Created Date:  2013-06-19     Completed Date:  2013-11-04     Revised Date:  2014-07-29    
Medline Journal Info:
Nlm Unique ID:  8610640     Medline TA:  J Bone Miner Res     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1688-98     Citation Subset:  IM    
Copyright Information:
Copyright © 2013 American Society for Bone and Mineral Research.
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MeSH Terms
Descriptor/Qualifier:
Absorptiometry, Photon
Adult
Body Weight*
Bone Density*
C-Reactive Protein / metabolism*
Female
Femoral Neck Fractures / blood*,  radiography
Follow-Up Studies
Humans
Lumbosacral Region / radiography
Middle Aged
Models, Biological*
Postmenopause / blood*
Premenopause / blood*
Spinal Fractures / blood*,  radiography
United States
Women's Health
Grant Support
ID/Acronym/Agency:
AG012495/AG/NIA NIH HHS; AG012505/AG/NIA NIH HHS; AG012531/AG/NIA NIH HHS; AG012535/AG/NIA NIH HHS; AG012539/AG/NIA NIH HHS; AG012546/AG/NIA NIH HHS; AG012553/AG/NIA NIH HHS; AG012554/AG/NIA NIH HHS; AG026463/AG/NIA NIH HHS; NR004061/NR/NINR NIH HHS; P30 AG028748/AG/NIA NIH HHS; P30‐AG028748/AG/NIA NIH HHS; R01 AG026463/AG/NIA NIH HHS; R01‐AG033067/AG/NIA NIH HHS
Chemical
Reg. No./Substance:
9007-41-4/C-Reactive Protein
Comments/Corrections

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