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Association of hemoglobin level with fracture: a nationwide cohort study
Ji Soo Kim1, Seulggie Choi2, Gyeongsil Lee1
1Department of Family Medicine, Seoul National University Hospital, Seoul, South Korea.
Insights
Anemia and low hemoglobin (Hb) levels increase fracture risk in adults over 50. This finding highlights Hb as a crucial factor in bone health and fracture prevention strategies.
Area of Science:
- Gerontology
- Hematology
- Orthopedics
Background:
- The relationship between hemoglobin (Hb) levels, including anemia, and fracture risk requires further investigation.
- Previous studies have not thoroughly explored the association between Hb levels and fracture incidence.
Purpose of the Study:
- To investigate the association between hemoglobin levels and the risk of fracture in adults aged 50 years and older.
- To determine if anemia or low-normal Hb levels are independent risk factors for fracture.
Main Methods:
- A cohort of 197,187 adults aged ≥50 years from South Korea was analyzed.
- Hemoglobin levels were measured during health screening, and participants were followed for fracture occurrence from 2006 to 2013.
- Cox proportional hazards regression models were used to calculate adjusted hazard ratios (aHRs) for fracture based on Hb categories.
Main Results:
- Individuals with anemia and low-normal Hb levels exhibited a significantly increased risk of fracture compared to those with normal Hb.
- In women, anemia was linked to higher risks of any fracture, hip fracture, and radius fracture.
- In men, anemia was associated with increased risks of any fracture, vertebral fracture, and hip fracture.
Conclusions:
- Anemia and low-normal hemoglobin levels are identified as significant risk factors for fracture in adults aged 50 and above.
- These findings underscore the importance of monitoring Hb levels in older adults for fracture risk assessment.
Introduction:
The association between hemoglobin (Hb) level including anemia and fracture has not been studied thoroughly.
Materials And Methods:
197, 187 adults ≥ 50 years from the National Health Insurance Service of Korea were studied. Hb was determined during health screening examinations in 2004 or 2005. From 1 January 2006, participants were followed up for fracture until 31 December 2013. Hb levels (g/dL) were categorized into five groups, with normal hemoglobin levels subdivided into three groups (low normal, normal, and high normal Hb): < 13, ≥ 13 to < 14, ≥ 14 to < 16, ≥ 16 to < 17, 17 for men and < 12, ≥ 12 to < 13, ≥ 13 to < 14, ≥ 14 to < 16, ≥ 16 for women. Anemia was defined as Hb < 13 g/dL and < 12 g/dL for men and women, respectively. Cox proportional hazards regression was used to determine the adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs) for fracture according to Hb.
Results:
Compared to individuals with normal Hb, those with anemia and low normal Hb were associated with significantly increased risk of fracture. In women, those with anemia had a higher risk for any (aHR 1.11, 95% CI 1.05-1.17), hip (aHR 1.27, 95% CI 1.01-1.59), and radius fracture (aHR 1.15, 95% CI 1.05-1.25). In men, those with anemia had a higher risk for any (aHR 1.37, 95% CI 1.23-1.51), vertebral (aHR 1.33, 95% CI 1.15-1.53), and hip fracture (aHR 1.64, 95% CI 1.30-2.08). This risk-enhancing association was preserved among various subgroups.
Conclusion:
Among adults ≥ 50 years, anemia and low normal Hb are risk factors for fracture.
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