Cystatin-C, renal function, and incidence of hip fracture in postmenopausal women

Andrea Z. LaCroix, Jennifer S. Lee, LieLing Wu, Jane A. Cauley, Michael G. Shlipak, Susan M. Ott, John A Robbins, J. David Curb, Meryl Leboff, Douglas C. Bauer, Rebecca D. Jackson, Charles L. Kooperberg, Steven R. Cummings

Research output: Contribution to journalArticle

52 Citations (Scopus)

Abstract

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 m 2, 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 eGFR cys-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.

Original languageEnglish (US)
Pages (from-to)1434-1441
Number of pages8
JournalJournal of the American Geriatrics Society
Volume56
Issue number8
DOIs
StatePublished - Aug 2008

Fingerprint

Cystatin C
Hip Fractures
Kidney
Incidence
Odds Ratio
Homocysteine
Confidence Intervals
Chronic Renal Insufficiency
Serum
Women's Health
Glomerular Filtration Rate
Vitamin D
Alcohol Drinking
Health Status
Observational Studies
Case-Control Studies
Hemoglobins
Biomarkers
Smoking
Prospective Studies

Keywords

  • Chronic kidney disease
  • Cystatin-C
  • Hip fracture
  • Renal function

ASJC Scopus subject areas

  • Geriatrics and Gerontology

Cite this

LaCroix, A. Z., Lee, J. S., Wu, L., Cauley, J. A., Shlipak, M. G., Ott, S. M., ... Cummings, S. R. (2008). Cystatin-C, renal function, and incidence of hip fracture in postmenopausal women. Journal of the American Geriatrics Society, 56(8), 1434-1441. https://doi.org/10.1111/j.1532-5415.2008.01807.x

Cystatin-C, renal function, and incidence of hip fracture in postmenopausal women. / LaCroix, Andrea Z.; Lee, Jennifer S.; Wu, LieLing; Cauley, Jane A.; Shlipak, Michael G.; Ott, Susan M.; Robbins, John A; Curb, J. David; Leboff, Meryl; Bauer, Douglas C.; Jackson, Rebecca D.; Kooperberg, Charles L.; Cummings, Steven R.

In: Journal of the American Geriatrics Society, Vol. 56, No. 8, 08.2008, p. 1434-1441.

Research output: Contribution to journalArticle

LaCroix, AZ, Lee, JS, Wu, L, Cauley, JA, Shlipak, MG, Ott, SM, Robbins, JA, Curb, JD, Leboff, M, Bauer, DC, Jackson, RD, Kooperberg, CL & Cummings, SR 2008, 'Cystatin-C, renal function, and incidence of hip fracture in postmenopausal women', Journal of the American Geriatrics Society, vol. 56, no. 8, pp. 1434-1441. https://doi.org/10.1111/j.1532-5415.2008.01807.x
LaCroix, Andrea Z. ; Lee, Jennifer S. ; Wu, LieLing ; Cauley, Jane A. ; Shlipak, Michael G. ; Ott, Susan M. ; Robbins, John A ; Curb, J. David ; Leboff, Meryl ; Bauer, Douglas C. ; Jackson, Rebecca D. ; Kooperberg, Charles L. ; Cummings, Steven R. / Cystatin-C, renal function, and incidence of hip fracture in postmenopausal women. In: Journal of the American Geriatrics Society. 2008 ; Vol. 56, No. 8. pp. 1434-1441.
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abstract = "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 m 2, 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 eGFR cys-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.",
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AU - Shlipak, Michael G.

AU - Ott, Susan M.

AU - Robbins, John A

AU - Curb, J. David

AU - Leboff, Meryl

AU - Bauer, Douglas C.

AU - Jackson, Rebecca D.

AU - Kooperberg, Charles L.

AU - Cummings, Steven R.

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N2 - 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 m 2, 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 eGFR cys-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.

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