Evidence map›Paper›PMID 33576845›Full record

ArticleOsteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA2021

Associations of hemoglobin and change in hemoglobin with risk of incident hip fracture in older men and women: the cardiovascular health study.

R J Valderrábano, P Buzkova, P-Y Chang, N A Zakai, H A Fink, J A Robbins, J Y Wu, J S Lee, Cardiovascular Health Study group

Open access · greenAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 12 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
12citing papers in PubMed, 1 pooled it
1.5field-weighted citation impact, top 18% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

12 citing papers in PubMed, 1 synthesis or guideline pooled it, 16 citations in OpenAlex.

  1. Pooled it
  2. Increased fracture risk associated with iron-deficiency anemia: a population-based propensity score matched cohort study.Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA · 2026
    Article
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  8. Review
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  11. Osteoblast Lineage Support of Hematopoiesis in Health and Disease.Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research · 2022
    Review
  12. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

9 authors at 6 institutions in 1 country.

R J Valderrábano *University of Miami Miller School of Medicine, P.O. Box 016960 (D-56), Miami, FL, 33101, USA. rvalderrabano@med.miami.edu.
P BuzkovaDepartment of Biostatistics, University of Washington, Seattle, WA, USA.
P-Y ChangDivision of Endocrinology, Stanford University School of Medicine, 300 Pasteur Dr., S-025, Stanford, CA, 94305, USA.
N A ZakaiDepartment of Medicine and Department of Pathology and Laboratory Medicine, Larner College of Medicine at the University of Vermont, Burlington, VT, USA.
H A FinkGRECC, Veteran Affairs Health Care System, Minneapolis, MN, USA.
J A RobbinsSchool of Medicine, University of California, Davis, CA, USA.
J Y Wu *Division of Endocrinology, Stanford University School of Medicine, 300 Pasteur Dr., S-025, Stanford, CA, 94305, USA. jywu1@stanford.edu.
J S Lee *Division of Endocrinology, Stanford University School of Medicine, 300 Pasteur Dr., S-025, Stanford, CA, 94305, USA.
Cardiovascular Health Study group
Stanford University · USUniversity of California, Davis · USGeriatric Research Education and Clinical Center · USUniversity of Miami · USUniversity of Vermont · USUniversity of Washington · US

Funding

Exceptional Survival: Trajectories to Functional Aging (CHS All Stars)R01AG023629 · NIA · UNIVERSITY OF PITTSBURGH AT PITTSBURGH · PI NEWMAN, ANNE B. · 2004 to 2016
$9.5M
Diabetes, Endocrinology and Metabolism Training GrantT32DK007217 · NIDDK · STANFORD UNIVERSITY · PI Justin Pierce Annes, David Matthew Maahs · 1987 to 2026
$7.2M
CHS research resources for the cardiovascular health of older adultsU01HL130114 · NHLBI · UNIVERSITY OF WASHINGTON · PI BURKE, GREGORY L, KRONMAL, RICHARD A · 2016 to 2019
$6.6M
CHS Events Follow-up StudyU01HL080295 · NHLBI · UNIVERSITY OF WASHINGTON · PI PSATY, BRUCE M · 2005 to 2008
$4.6M
Role of EIIIA fibronectin in pulmonary fibrosisR01HL085083 · NHLBI · UNIVERSITY OF MICHIGAN AT ANN ARBOR · PI WHITE, ERIC S · 2007 to 2011
$1.9M
CORONARY HEART DISEASE &STROKE IN PEOPLE AGED 65-84N01HC085083 · HC · UNIVERSITY OF CALIFORNIA DAVIS · PI ROBBINS, JOHN A · 1988 to 1999
–
CHS-Transition Phase -268055222-268055222N01HC055222 · HC · UNIVERSITY OF WASHINGTON · PI KRONMAL, RICHARD A · 2005 to 2006
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CENTRAL BLOOD ANALYSIS LABORATORY FOR CHSN01HC085086 · HC · UNIVERSITY OF VERMONT &ST AGRIC COLLEGE · PI TRACY, RUSSELL P · 1988 to 2000
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CORONARY HEART DISEASE &STROKE IN PEOPLE AGED 65 TO 84N01HC085079 · HC · UNIVERSITY OF WASHINGTON · 1988 to 2005
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CORONARY HEART DISEASE &STROKE IN THE ELDERLYN01HC085080 · HC · WAKE FOREST UNIVERSITY · PI BURKE, GREGORY L · 1988 to 2000
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CORONARY HEART DISEASE &STROKE IN PEOPLE AGED 65-84N01HC085081 · HC · JOHNS HOPKINS UNIVERSITY · PI FRIED, LINDA P · 1988 to 2000
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CORONARY HEART DISEASE AND STROKE IN PEOPLE AGED 65-84N01HC085082 · HC · UNIVERSITY OF PITTSBURGH AT PITTSBURGH · PI KULLER, LEWIS H · 1988 to 2000
–
NHLBI NIH HHS HHSN268200800007CNHLBI NIH HHS HHSN268201200036CNHLBI NIH HHS HHSN268201800001CNHLBI NIH HHS N01 HC055222NHLBI NIH HHS N01 HC085079NHLBI NIH HHS N01 HC085080NHLBI NIH HHS N01 HC085081NHLBI NIH HHS N01 HC085082NHLBI NIH HHS N01 HC085083NHLBI NIH HHS N01 HC085086NHLBI NIH HHS U01 HL080295NHLBI NIH HHS U01HL080295NHLBI NIH HHS U01 HL130114NIA NIH HHS R01 AG023629NIA NIH HHS R01AG023629NIDDK NIH HHS T32 DK007217
6 · The paper itself

Abstract

In a multi-site longitudinal cohort study, decreasing hemoglobin was associated with increased hip fracture risk in men. Anemia was associated with hip fracture in men and in African American women. Decreasing hemoglobin may be a marker of progressing bone fragility, making its serial measurement useful for fracture risk stratification.

introductionHematopoiesis and bone health are interdependent. Anemia has been associated with risk of fracture in humans. To further elucidate this relationship, we hypothesized that decreasing hemoglobin could indicate defective hematopoiesis and would also predict fracture risk.

methodsWe performed a prospective analysis from study baseline (1992) of the Cardiovascular Health Study, a multi-site longitudinal cohort study. A total of 4670 men and women, ages >65 years, who were able to consent and not institutionalized or wheelchair bound, had hemoglobin (Hb) measured in 1992. For 4006 subjects, Hb change from 1989 to 1992 was annualized and divided into sex-specific quartiles. Incident hip fractures were verified against Medicare claims data during a median follow-up of 11.8 years.

resultsNested Cox proportional-hazard models estimated association of hip fracture with anemia (men Hb <13 g/dL, women Hb <12 g/dL) and separately, greatest Hb decrease (versus others). Anemia was associated with increased hip fracture risk in all men (HR 1.59; 95% CI 1.01-2.50) and African American women (HR 3.21; 95% CI 1.07-9.63). In men, an annualized Hb loss of >0.36 g/dL/year was associated with a higher risk of hip fracture (HR 1.67; 95% CI 1.10-2.54), which was lessened by anemia at the start of fracture follow-up (HR 1.53; 95% CI 0.99-2.39).

conclusionsDecreasing Hb may be an early marker for subsequent hip fracture risk in men, which may be less informative once an anemia threshold is crossed. Only African American women with anemia had increased hip fracture risk, suggesting a race difference in this relationship.

Indexed as

Hip FracturesMedicareAgedFemaleHemoglobinsHumansLongitudinal StudiesMaleRisk FactorsUnited StatesHemoglobinsAnemiaFracture preventionFracture risk assessmentHip fractureOsteoporosis

Identifiers

PMID33576845
PMCPMC8764634
OpenAlexW3129166629

What Socratic holds

Textmetadata
LicenceTDM
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.