Association of bone mineral density with hemoglobin and change in hemoglobin among older men and women: The Cardiovascular Health Study

the Cardiovascular Health Study group, Rodrigo J. Valderrábano, Petra Buzkova, Po Yin Chang, Neil A. Zakai, Howard A. Fink, John A Robbins, Jennifer S. Lee, Joy Y. Wu

Research output: Contribution to journalArticle

Abstract

Purpose: Osteoblasts and their precursors support hematopoiesis in the bone marrow. We hypothesized that declines in Hgb levels are associated with bone mineral density (BMD). Methods: The Cardiovascular Health Study is a prospective longitudinal study that enrolled 5888 community-dwelling adults aged >65 years and measured hemoglobin twice, in 1989–90 and 1992–93, as well as BMD by dual-energy X-ray absorptiometry (DXA) in 1994–95. In a subset of 1513 men and women with a Hgb in 1992–93 and BMD, we used linear regression to estimate associations of Hgb (per standard deviation (SD)) with total hip (TH), lumbar spine (LS) and total body (TB) BMD, and used Poisson regression to estimate associations of anemia (in 1992–93; Hgb <13 g/dL in men; <12 g/dL in women) with “low BMD” defined as T-score less than −1 at the TH. In 1277 participants with Hgb measured on average 2.9 years apart and BMD, we used linear regression to estimate the associations of annualized change in Hgb with TH, LS and TB BMD. All models included age, sex, study-site, race, smoking, alcohol use, weight, height, steroid use, physical activity score, self-reported health, previous cardiovascular disease and prior anti-fracture medication use. Results: No significant association was observed between Hgb, measured a mean 2.2 years prior to BMD, and BMD at the TH and LS in men (TH beta = −0.60 [x 10−2 g/cm2per 1.1 g/dL Hgb], 95% CI: -1.88 to 0.68; LS beta = −1.69, 95% CI: -3.83 to 0.45) or women (TH beta = −0.49 [x 10−2 g/cm2per 1.3 g/dL Hgb], 95% CI: -1.57 to 0.59; LS beta = −0.40, 95% CI: -2.57 to 1.76). Anemia was not observed to be significantly associated with low BMD in men (RR = 0.99, 95% CI: 0.72–1.40) nor women (RR = 0.98, 95% CI: 0.82–1.17). The mean change in Hgb was a loss of 0.06 g/dL/year (SD = 0.32). Change in Hgb was not observed to be significantly associated with BMD in men (TH beta = −0.55[x 10−2 g/cm2per 1 g/dL annualized Hgb change], 95% CI: -4.28 to 3.19; LS beta = 0.63, 95% CI: -5.38 to 6.65) or women (TH beta = 0.92, 95% CI: -1.96 to 3.79; LS beta = −1.77, 95% CI: -7.52 to 3.98). No significant association was observed between anemia and low bone density by T-score in men and women. Conclusions: These findings support neither the hypothesis that low Hgb prior to bone density or decreases in Hgb are associated with bone density in older community-dwelling adults nor the use of Hgb level as a case-finding tool to prompt BMD measurement.

LanguageEnglish (US)
Pages321-326
Number of pages6
JournalBone
Volume120
DOIs
StatePublished - Mar 1 2019

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Bone Density
Hemoglobins
Health
Hip
Spine
Independent Living
Anemia
Linear Models
Photon Absorptiometry
Hematopoiesis
Osteoblasts
Longitudinal Studies
Cardiovascular Diseases
Bone Marrow
Smoking
Steroids
Alcohols
Prospective Studies

Keywords

  • Aging
  • Bone mineral density
  • Hematopoiesis
  • Hemoglobin
  • White blood cells

ASJC Scopus subject areas

  • Endocrinology, Diabetes and Metabolism
  • Physiology
  • Histology

Cite this

Association of bone mineral density with hemoglobin and change in hemoglobin among older men and women : The Cardiovascular Health Study. / the Cardiovascular Health Study group.

In: Bone, Vol. 120, 01.03.2019, p. 321-326.

Research output: Contribution to journalArticle

@article{09293006f963422f916002594e1d9e9f,
title = "Association of bone mineral density with hemoglobin and change in hemoglobin among older men and women: The Cardiovascular Health Study",
abstract = "Purpose: Osteoblasts and their precursors support hematopoiesis in the bone marrow. We hypothesized that declines in Hgb levels are associated with bone mineral density (BMD). Methods: The Cardiovascular Health Study is a prospective longitudinal study that enrolled 5888 community-dwelling adults aged >65 years and measured hemoglobin twice, in 1989–90 and 1992–93, as well as BMD by dual-energy X-ray absorptiometry (DXA) in 1994–95. In a subset of 1513 men and women with a Hgb in 1992–93 and BMD, we used linear regression to estimate associations of Hgb (per standard deviation (SD)) with total hip (TH), lumbar spine (LS) and total body (TB) BMD, and used Poisson regression to estimate associations of anemia (in 1992–93; Hgb <13 g/dL in men; <12 g/dL in women) with “low BMD” defined as T-score less than −1 at the TH. In 1277 participants with Hgb measured on average 2.9 years apart and BMD, we used linear regression to estimate the associations of annualized change in Hgb with TH, LS and TB BMD. All models included age, sex, study-site, race, smoking, alcohol use, weight, height, steroid use, physical activity score, self-reported health, previous cardiovascular disease and prior anti-fracture medication use. Results: No significant association was observed between Hgb, measured a mean 2.2 years prior to BMD, and BMD at the TH and LS in men (TH beta = −0.60 [x 10−2 g/cm2per 1.1 g/dL Hgb], 95{\%} CI: -1.88 to 0.68; LS beta = −1.69, 95{\%} CI: -3.83 to 0.45) or women (TH beta = −0.49 [x 10−2 g/cm2per 1.3 g/dL Hgb], 95{\%} CI: -1.57 to 0.59; LS beta = −0.40, 95{\%} CI: -2.57 to 1.76). Anemia was not observed to be significantly associated with low BMD in men (RR = 0.99, 95{\%} CI: 0.72–1.40) nor women (RR = 0.98, 95{\%} CI: 0.82–1.17). The mean change in Hgb was a loss of 0.06 g/dL/year (SD = 0.32). Change in Hgb was not observed to be significantly associated with BMD in men (TH beta = −0.55[x 10−2 g/cm2per 1 g/dL annualized Hgb change], 95{\%} CI: -4.28 to 3.19; LS beta = 0.63, 95{\%} CI: -5.38 to 6.65) or women (TH beta = 0.92, 95{\%} CI: -1.96 to 3.79; LS beta = −1.77, 95{\%} CI: -7.52 to 3.98). No significant association was observed between anemia and low bone density by T-score in men and women. Conclusions: These findings support neither the hypothesis that low Hgb prior to bone density or decreases in Hgb are associated with bone density in older community-dwelling adults nor the use of Hgb level as a case-finding tool to prompt BMD measurement.",
keywords = "Aging, Bone mineral density, Hematopoiesis, Hemoglobin, White blood cells",
author = "{the Cardiovascular Health Study group} and Valderr{\'a}bano, {Rodrigo J.} and Petra Buzkova and Chang, {Po Yin} and Zakai, {Neil A.} and Fink, {Howard A.} and Robbins, {John A} and Lee, {Jennifer S.} and Wu, {Joy Y.}",
year = "2019",
month = "3",
day = "1",
doi = "10.1016/j.bone.2018.11.010",
language = "English (US)",
volume = "120",
pages = "321--326",
journal = "Bone",
issn = "8756-3282",
publisher = "Elsevier Inc.",

}

TY - JOUR

T1 - Association of bone mineral density with hemoglobin and change in hemoglobin among older men and women

T2 - Bone

AU - the Cardiovascular Health Study group

AU - Valderrábano, Rodrigo J.

AU - Buzkova, Petra

AU - Chang, Po Yin

AU - Zakai, Neil A.

AU - Fink, Howard A.

AU - Robbins, John A

AU - Lee, Jennifer S.

AU - Wu, Joy Y.

PY - 2019/3/1

Y1 - 2019/3/1

N2 - Purpose: Osteoblasts and their precursors support hematopoiesis in the bone marrow. We hypothesized that declines in Hgb levels are associated with bone mineral density (BMD). Methods: The Cardiovascular Health Study is a prospective longitudinal study that enrolled 5888 community-dwelling adults aged >65 years and measured hemoglobin twice, in 1989–90 and 1992–93, as well as BMD by dual-energy X-ray absorptiometry (DXA) in 1994–95. In a subset of 1513 men and women with a Hgb in 1992–93 and BMD, we used linear regression to estimate associations of Hgb (per standard deviation (SD)) with total hip (TH), lumbar spine (LS) and total body (TB) BMD, and used Poisson regression to estimate associations of anemia (in 1992–93; Hgb <13 g/dL in men; <12 g/dL in women) with “low BMD” defined as T-score less than −1 at the TH. In 1277 participants with Hgb measured on average 2.9 years apart and BMD, we used linear regression to estimate the associations of annualized change in Hgb with TH, LS and TB BMD. All models included age, sex, study-site, race, smoking, alcohol use, weight, height, steroid use, physical activity score, self-reported health, previous cardiovascular disease and prior anti-fracture medication use. Results: No significant association was observed between Hgb, measured a mean 2.2 years prior to BMD, and BMD at the TH and LS in men (TH beta = −0.60 [x 10−2 g/cm2per 1.1 g/dL Hgb], 95% CI: -1.88 to 0.68; LS beta = −1.69, 95% CI: -3.83 to 0.45) or women (TH beta = −0.49 [x 10−2 g/cm2per 1.3 g/dL Hgb], 95% CI: -1.57 to 0.59; LS beta = −0.40, 95% CI: -2.57 to 1.76). Anemia was not observed to be significantly associated with low BMD in men (RR = 0.99, 95% CI: 0.72–1.40) nor women (RR = 0.98, 95% CI: 0.82–1.17). The mean change in Hgb was a loss of 0.06 g/dL/year (SD = 0.32). Change in Hgb was not observed to be significantly associated with BMD in men (TH beta = −0.55[x 10−2 g/cm2per 1 g/dL annualized Hgb change], 95% CI: -4.28 to 3.19; LS beta = 0.63, 95% CI: -5.38 to 6.65) or women (TH beta = 0.92, 95% CI: -1.96 to 3.79; LS beta = −1.77, 95% CI: -7.52 to 3.98). No significant association was observed between anemia and low bone density by T-score in men and women. Conclusions: These findings support neither the hypothesis that low Hgb prior to bone density or decreases in Hgb are associated with bone density in older community-dwelling adults nor the use of Hgb level as a case-finding tool to prompt BMD measurement.

AB - Purpose: Osteoblasts and their precursors support hematopoiesis in the bone marrow. We hypothesized that declines in Hgb levels are associated with bone mineral density (BMD). Methods: The Cardiovascular Health Study is a prospective longitudinal study that enrolled 5888 community-dwelling adults aged >65 years and measured hemoglobin twice, in 1989–90 and 1992–93, as well as BMD by dual-energy X-ray absorptiometry (DXA) in 1994–95. In a subset of 1513 men and women with a Hgb in 1992–93 and BMD, we used linear regression to estimate associations of Hgb (per standard deviation (SD)) with total hip (TH), lumbar spine (LS) and total body (TB) BMD, and used Poisson regression to estimate associations of anemia (in 1992–93; Hgb <13 g/dL in men; <12 g/dL in women) with “low BMD” defined as T-score less than −1 at the TH. In 1277 participants with Hgb measured on average 2.9 years apart and BMD, we used linear regression to estimate the associations of annualized change in Hgb with TH, LS and TB BMD. All models included age, sex, study-site, race, smoking, alcohol use, weight, height, steroid use, physical activity score, self-reported health, previous cardiovascular disease and prior anti-fracture medication use. Results: No significant association was observed between Hgb, measured a mean 2.2 years prior to BMD, and BMD at the TH and LS in men (TH beta = −0.60 [x 10−2 g/cm2per 1.1 g/dL Hgb], 95% CI: -1.88 to 0.68; LS beta = −1.69, 95% CI: -3.83 to 0.45) or women (TH beta = −0.49 [x 10−2 g/cm2per 1.3 g/dL Hgb], 95% CI: -1.57 to 0.59; LS beta = −0.40, 95% CI: -2.57 to 1.76). Anemia was not observed to be significantly associated with low BMD in men (RR = 0.99, 95% CI: 0.72–1.40) nor women (RR = 0.98, 95% CI: 0.82–1.17). The mean change in Hgb was a loss of 0.06 g/dL/year (SD = 0.32). Change in Hgb was not observed to be significantly associated with BMD in men (TH beta = −0.55[x 10−2 g/cm2per 1 g/dL annualized Hgb change], 95% CI: -4.28 to 3.19; LS beta = 0.63, 95% CI: -5.38 to 6.65) or women (TH beta = 0.92, 95% CI: -1.96 to 3.79; LS beta = −1.77, 95% CI: -7.52 to 3.98). No significant association was observed between anemia and low bone density by T-score in men and women. Conclusions: These findings support neither the hypothesis that low Hgb prior to bone density or decreases in Hgb are associated with bone density in older community-dwelling adults nor the use of Hgb level as a case-finding tool to prompt BMD measurement.

KW - Aging

KW - Bone mineral density

KW - Hematopoiesis

KW - Hemoglobin

KW - White blood cells

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U2 - 10.1016/j.bone.2018.11.010

DO - 10.1016/j.bone.2018.11.010

M3 - Article

VL - 120

SP - 321

EP - 326

JO - Bone

JF - Bone

SN - 8756-3282

ER -