Association of Hypoalbuminemia With Osteoporosis: Analysis of the National Health and Nutrition Examination Survey

Afshinnia, Farsad; Pennathur, Subramaniam

doi:10.1210/jc.2016-1099

Cited by 38 publications

(21 citation statements)

References 32 publications

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“…Our results are in line with numerous evidences of multidirectional (patho)physiological links between the skeleton as a dynamic, metabolically active organ and the cardiovascular, renal, liver, endocrine, nervous and immune systems. Our observations complement the results from many previous studies showing positive bi- and multi-directional relationships between osteoporosis, falls and fractures, on one hand, and chronic conditions such as CKD 71 , 85 - 90 , CVDs 91 - 104 , anaemia 105 - 111 , hypoalbuminaemia 112 - 114 and hyperthyroidism 115 - 119 on the other, supporting the concept that osteoporosis is a systemic disease.…”

Section: Discussionsupporting

confidence: 89%

Bone Turnover Status: Classification Model and Clinical Implications

Fisher¹,

Fisher²,

Srikusalanukul³

et al. 2018

Int. J. Med. Sci.

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Aim: To develop a practical model for classification bone turnover status and evaluate its clinical usefulness.Methods: Our classification of bone turnover status is based on internationally recommended biomarkers of both bone formation (N-terminal propeptide of type1 procollagen, P1NP) and bone resorption (beta C-terminal cross-linked telopeptide of type I collagen, bCTX), using the cutoffs proposed as therapeutic targets. The relationships between turnover subtypes and clinical characteristic were assessed in1223 hospitalised orthogeriatric patients (846 women, 377 men; mean age 78.1±9.50 years): 451(36.9%) subjects with hip fracture (HF), 396(32.4%) with other non-vertebral (non-HF) fractures (HF) and 376 (30.7%) patients without fractures.Resalts: Six subtypes of bone turnover status were identified: 1 - normal turnover (P1NP>32 μg/L, bCTX≤0.250 μg/L and P1NP/bCTX>100.0[(median value]); 2- low bone formation (P1NP ≤32 μg/L), normal bone resorption (bCTX≤0.250 μg/L) and P1NP/bCTX>100.0 (subtype2A) or P1NP/bCTX<100.0 (subtype 2B); 3- low bone formation, high bone resorption (bCTX>0.250 μg/L) and P1NP/bCTX<100.0; 4- high bone turnover (both markers elevated ) and P1NP/bCTX>100.0 (subtype 4A) or P1NP/bCTX<100.0 (subtype 4B). Compared to subtypes 1 and 2A, subtype 2B was strongly associated with nonvertebral fractures (odds ratio [OR] 2.0), especially HF (OR 3.2), age>75 years and hyperparathyroidism. Hypoalbuminaemia and not using osteoporotic therapy were two independent indicators common for subtypes 3, 4A and 4B; these three subtypes were associated with in-hospital mortality. Subtype 3 was associated with fractures (OR 1.7, for HF OR 2.4), age>75 years, chronic heart failure (CHF), anaemia, and history of malignancy, and predicted post-operative myocardial injury, high inflammatory response and length of hospital stay (LOS) above10 days. Subtype 4A was associated with chronic kidney disease (CKD), anaemia, history of malignancy and walking aids use and predicted LOS>20 days, but was not discriminative for fractures. Subtype 4B was associated with fractures (OR 2.1, for HF OR 2.5), age>75 years, CKD and indicated risks of myocardial injury, high inflammatory response and LOS>10 days.Conclusions: We proposed a classification model of bone turnover status and demonstrated that in orthogeriatric patients altered subtypes are closely related to presence of nonvertebral fractures, comorbidities and poorer in-hospital outcomes. However, further research is needed to establish optimal cut points of various biomarkers and improve the classification model.

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Section: Discussionsupporting

confidence: 89%

Bone Turnover Status: Classification Model and Clinical Implications

Fisher¹,

Fisher²,

Srikusalanukul³

et al. 2018

Int. J. Med. Sci.

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“…Hypoalbuminemia could be caused and/or aggravated by numerous chronic diseases associated with increased risk of falls and fractures 26,27. Hypoalbuminemia may directly and indirectly influence bone status, shifting the balance toward bone resorption via its effects on the nuclear factor-kB, disturbed inflammatory and antioxidant responses, reduced flux of minerals to and from the bone, decreased formation of calcium phosphate apatite crystals, as well as affecting the metabolism of PTH, vitamin D binding protein, and Gla-protein 32,45…”

Section: Discussionmentioning

confidence: 99%

Lower-serum P1NP/βCTX ratio and hypoalbuminemia are independently associated with osteoporotic nonvertebral fractures in older adults

Fisher¹,

Srikusalanukul²,

Fisher³

et al. 2017

CIA

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PurposeTo estimate the discriminative value of serum P1NP/βCTX ratio and albumin levels in hospitalized orthogeriatric patients with and without nonvertebral fractures.MethodsIn 1,239 orthogeriatric patients (mean age 78.1±9.52 years, 69.1% women) including 854 (68.9%) with osteoporotic nonvertebral fractures (455 [36.7%] with hip fracture [HF]) and 385 (31.1%) without fractures, markers of bone formation (procollagen type 1 N-terminal propeptide [P1NP], osteocalcin [OC], and bone resorption (beta-C-terminal cross-linking telopeptide of type 1 collagen [βCTX]), indices of mineral metabolism, and parameters of liver and renal functions were assessed; data on clinical and laboratory characteristics were collected prospectively.ResultsBoth lower serum P1NP/βCTX ratio and albumin concentration (as continuous or categorical variables) were independently associated with fracture presence in multivariate logistic regressions. Compared with the highest P1NP/βCTX tertile, the prevalence of HF, after adjustment for multiple covariates, was 3-fold higher in the lowest tertile and 1.5 times higher in the middle tertile; presence of any fracture was 2.3- and 1.6-fold higher, respectively; patients with albumin levels in the lowest tertile had multivariate odds ratio (OR) of 4.6 for HF and 2.8 for any fracture, in the middle tertile the ORs were 2.2 and 1.3, respectively. The P1NP/βCTX <100.0 (median) and hypoalbuminemia (<33 g/L) demonstrated area under the curve values for HF of 0.802 and 0.806, respectively, and for any fractures of 0.711 and 0.706, respectively. When both characteristics were combined, the ORs for HF or any fracture, compared with the nonfractured group, were 7.8 and 3.2, respectively, with an accuracy of 79.6% and 71.6%, respectively.ConclusionsIn orthogeriatric patients, both serum P1NP/βCTX ratio and albumin levels demonstrated an inverse dose–effect relationship with the prevalence of nonvertebral fractures and independently indicated fracture presence with acceptable discriminatory power. Lower P1NP/βCTX (<100) and hypoalbuminemia could be useful simple additive prognostic tools for fracture risk stratification in the elderly.

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“…Metabolic acidosis suppress albumin synthesis 49 and increase skeletal muscle catabolism 50, 51 in these patients. Analysis of a national dataset find a significantly increased risk of osteoporosis among general population with hypoalbuminemia; with albumin <3.5g/dL patients has 5.37 fold at femoral neck, 12.46 fold at total femur, and 4.59 fold at lumbar spine higher risk of osteoporosis as compared to those with albumin >4 mg/dL 52.…”

Section: Introductionmentioning

confidence: 92%

Hypoalbuminemia differently affects the serum bone turnover markers in hemodialysis patients

Zheng¹,

Wu²,

Lu³

et al. 2019

Int. J. Med. Sci.

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Renal osteodystrophy (ROD) represents bone disorders related to chronic kidney disease (CKD) and several bone biomarkers are used clinically to predict ROD in CKD and hemodialysis (HD) patients. Serum albumin associates with inflammation other than nutritional status in these patients. Chronic inflammation is proved to relate with bone loss, however, the influence of hypoalbuminemia on bone biomarkers is still unclear. In this study, we evaluated the pattern of bone biomarker changes and further studied the influence of hypoalbuminemia on these biomarkers. A total of 300 maintenance HD patients were evaluated and 223 HD patients were included in the study. The patients were grouped according to serum parathyroid hormone (PTH) levels (PTH ≤150 pg/mL, PTH 150-300 pg/mL, PTH 300-600 pg/mL and PTH >600 pg/mL). Bone biomarkers and inflammatory markers were measured and their relation with PTH levels was determined. Significantly increased interleukin-6 (IL-6) and lower albumin levels were noted among PTH>600 pg/mL group. Bone turnover markers were significantly higher in PTH >600 pg/mL group (p< 0.05). Hypoalbuminemia significantly increased the fibroblast growth factor-23 (FGF-23) and procollagen type 1N-terminal propeptide (P1NP) in PTH ≤150 pg/mL, PTH 150-300 pg/mL, PTH 300-600 pg/mL groups, whereas no such relation was noted among PTH> 600 ng/dL group. In conclusion, hypoalbuminemia represents a chronic inflammation which differently relates to bone turnover markers according to serum PTH levels in SHPT patients. Thus, serum albumin measurement should be considered in determining bone disorders among these patients.

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Association of Hypoalbuminemia With Osteoporosis: Analysis of the National Health and Nutrition Examination Survey

Abstract: In the NHANES dataset, we report an independent association of osteoporosis with hypoalbuminemia at different anatomical sites.

Cited by 38 publications

References 32 publications

Bone Turnover Status: Classification Model and Clinical Implications

Bone Turnover Status: Classification Model and Clinical Implications

Lower-serum P1NP/βCTX ratio and hypoalbuminemia are independently associated with osteoporotic nonvertebral fractures in older adults

Hypoalbuminemia differently affects the serum bone turnover markers in hemodialysis patients

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Association of Hypoalbuminemia With Osteoporosis: Analysis of the National Health and Nutrition Examination Survey

Abstract: In the NHANES dataset, we report an independent association of osteoporosis with hypoalbuminemia at different anatomical sites.

Cited by 38 publications

References 32 publications

Bone Turnover Status: Classification Model and Clinical Implications

Bone Turnover Status: Classification Model and Clinical Implications

Lower-serum P1NP/&beta;CTX ratio and hypoalbuminemia are independently associated with osteoporotic nonvertebral fractures in older adults

Hypoalbuminemia differently affects the serum bone turnover markers in hemodialysis patients

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Lower-serum P1NP/βCTX ratio and hypoalbuminemia are independently associated with osteoporotic nonvertebral fractures in older adults