Ratio of urine albumin to creatinine attenuates the association of dementia with hip fracture risk

Petra Bužková, Joshua I. Barzilay, Howard A. Fink, John A Robbins, Jane A. Cauley, Annette L. Fitzpatrick

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Context: Microvascular disease is a leading cause of cognitive impairment. Approximately 50% of people with a hip fracture have cognitive impairment.

Objective: We tested the hypothesis that microvascular diseases of the brain (lacunar infarcts and white matter disease [WMD]), kidney (albuminuria [≥30 mg/g creatinine] and albumin creatinine ratio [ACR]), and eye (retinal vascular disorders) attenuate the association of cognitive impairment with hip fracture risk.

Setting: The Cardiovascular Health Cognition Study.

Patients: Three thousand, one-hundred six participants (mean age, ∼ 79 y; 8.84 y median follow-up) with cognitive testing. Subsets received ACR testing (n=2389), brain magnetic resonance imaging scans (n= 2094), and retinal photography (n= 1098).

Main Outcome Measure: Incident hip fracture.

Results: There were 488 participants (16%) with mild cognitive impairment (MCI) and 564 (18%) with dementia. There were 337 incident hip fractures, of which 19% occurred in participants with MCI and 26% in participants with dementia. Adjusted hazard ratios (HR) and 95% confidence interval for hip fracture in participants with MCI were 2.45 (1.67-3.61) and for dementia 2.35 (1.57-3.52). With doubling of ACR, the HR for fracture was attenuated in participants with dementia compared with participants with normal cognition [interaction HR 0.70 (0.55-0.91)]. No such effect was found in participants with MCI. Albuminuria, lacunar infarcts, WMD, and retinal vascular disease (RVD) did not modify the association of dementia or MCI with hip fracture risk.

Conclusions: ACR attenuates part of the risk of hip fracture in people with dementia, suggesting that these disorders share a common pathogenesis.

Original languageEnglish (US)
Pages (from-to)4116-4123
Number of pages8
JournalJournal of Clinical Endocrinology and Metabolism
Volume99
Issue number11
DOIs
StatePublished - Nov 1 2014

Fingerprint

Hip Fractures
Dementia
Albumins
Creatinine
Urine
Lacunar Stroke
Leukoencephalopathies
Retinal Vessels
Hazards
Albuminuria
Cognition
Brain
Retinal Diseases
Cognitive Dysfunction
Photography
Brain Diseases
Testing
Magnetic resonance
Vascular Diseases
Magnetic Resonance Imaging

ASJC Scopus subject areas

  • Biochemistry
  • Clinical Biochemistry
  • Endocrinology
  • Biochemistry, medical
  • Endocrinology, Diabetes and Metabolism
  • Medicine(all)

Cite this

Ratio of urine albumin to creatinine attenuates the association of dementia with hip fracture risk. / Bužková, Petra; Barzilay, Joshua I.; Fink, Howard A.; Robbins, John A; Cauley, Jane A.; Fitzpatrick, Annette L.

In: Journal of Clinical Endocrinology and Metabolism, Vol. 99, No. 11, 01.11.2014, p. 4116-4123.

Research output: Contribution to journalArticle

Bužková, Petra ; Barzilay, Joshua I. ; Fink, Howard A. ; Robbins, John A ; Cauley, Jane A. ; Fitzpatrick, Annette L. / Ratio of urine albumin to creatinine attenuates the association of dementia with hip fracture risk. In: Journal of Clinical Endocrinology and Metabolism. 2014 ; Vol. 99, No. 11. pp. 4116-4123.
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T1 - Ratio of urine albumin to creatinine attenuates the association of dementia with hip fracture risk

AU - Bužková, Petra

AU - Barzilay, Joshua I.

AU - Fink, Howard A.

AU - Robbins, John A

AU - Cauley, Jane A.

AU - Fitzpatrick, Annette L.

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N2 - Context: Microvascular disease is a leading cause of cognitive impairment. Approximately 50% of people with a hip fracture have cognitive impairment.Objective: We tested the hypothesis that microvascular diseases of the brain (lacunar infarcts and white matter disease [WMD]), kidney (albuminuria [≥30 mg/g creatinine] and albumin creatinine ratio [ACR]), and eye (retinal vascular disorders) attenuate the association of cognitive impairment with hip fracture risk.Setting: The Cardiovascular Health Cognition Study.Patients: Three thousand, one-hundred six participants (mean age, ∼ 79 y; 8.84 y median follow-up) with cognitive testing. Subsets received ACR testing (n=2389), brain magnetic resonance imaging scans (n= 2094), and retinal photography (n= 1098).Main Outcome Measure: Incident hip fracture.Results: There were 488 participants (16%) with mild cognitive impairment (MCI) and 564 (18%) with dementia. There were 337 incident hip fractures, of which 19% occurred in participants with MCI and 26% in participants with dementia. Adjusted hazard ratios (HR) and 95% confidence interval for hip fracture in participants with MCI were 2.45 (1.67-3.61) and for dementia 2.35 (1.57-3.52). With doubling of ACR, the HR for fracture was attenuated in participants with dementia compared with participants with normal cognition [interaction HR 0.70 (0.55-0.91)]. No such effect was found in participants with MCI. Albuminuria, lacunar infarcts, WMD, and retinal vascular disease (RVD) did not modify the association of dementia or MCI with hip fracture risk.Conclusions: ACR attenuates part of the risk of hip fracture in people with dementia, suggesting that these disorders share a common pathogenesis.

AB - Context: Microvascular disease is a leading cause of cognitive impairment. Approximately 50% of people with a hip fracture have cognitive impairment.Objective: We tested the hypothesis that microvascular diseases of the brain (lacunar infarcts and white matter disease [WMD]), kidney (albuminuria [≥30 mg/g creatinine] and albumin creatinine ratio [ACR]), and eye (retinal vascular disorders) attenuate the association of cognitive impairment with hip fracture risk.Setting: The Cardiovascular Health Cognition Study.Patients: Three thousand, one-hundred six participants (mean age, ∼ 79 y; 8.84 y median follow-up) with cognitive testing. Subsets received ACR testing (n=2389), brain magnetic resonance imaging scans (n= 2094), and retinal photography (n= 1098).Main Outcome Measure: Incident hip fracture.Results: There were 488 participants (16%) with mild cognitive impairment (MCI) and 564 (18%) with dementia. There were 337 incident hip fractures, of which 19% occurred in participants with MCI and 26% in participants with dementia. Adjusted hazard ratios (HR) and 95% confidence interval for hip fracture in participants with MCI were 2.45 (1.67-3.61) and for dementia 2.35 (1.57-3.52). With doubling of ACR, the HR for fracture was attenuated in participants with dementia compared with participants with normal cognition [interaction HR 0.70 (0.55-0.91)]. No such effect was found in participants with MCI. Albuminuria, lacunar infarcts, WMD, and retinal vascular disease (RVD) did not modify the association of dementia or MCI with hip fracture risk.Conclusions: ACR attenuates part of the risk of hip fracture in people with dementia, suggesting that these disorders share a common pathogenesis.

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