The relation between cortisol excretion and fractures in healthy older people: results from the MacArthur studies-Mac

In persons with depression, higher urinary cortisol is associated with lower bone mineral density.

To examine the relation between urinary free cortisol (UFC) and fractures.

Community-based samples from Durham, NC, East Boston, MA, and New Haven, CT.

684 men and women, aged 70 to 79 at baseline, who were part of the MacArthur Study of Successful Aging.

Cohort study. Participants with previous history of fractures at baseline were excluded.

The primary exposure variable was overnight (8:00 p.m. to 8:00 a.m.) UFC (microg/g creatinine) at baseline (1988). Outcomes were self-reported hip, arm, spine, wrist, or other fracture during the follow-up period (1988-1995). Covariates were baseline age, gender, race, body mass index, current physical activity, lower extremity strength, depression subscale of the Hopkins Symptom Checklist, and current use of cigarettes and alcohol.

Logistic regression was used to predict the occurrence of incident fractures (1988-1995) as a function of quartiles of baseline UFC. Models were adjusted for age, gender, and race and were also multiply adjusted for the remaining covariates listed above. Gender-stratified models and models that excluded corticosteroid users were also run.

In multiply adjusted models, higher baseline levels of UFC were significantly associated with incident fractures. Odds of fracture (95% Confidence Intervals) for increasing quartiles of baseline UFC, multiply adjusted, were: 2.28 (.91, 5.77); 3.40 (1.33, 8.69); 5.38 (1.68, 17.21). Results were not materially influenced by exclusion of persons using corticosteroids.

Higher baseline UFC is an independent predictor of future fracture.