C-reactive protein and fracture risk: an updated systematic review and meta-analysis of cohort studies through the use of both frequentist and Bayesian approaches

Mun, Heejin; Liu, Bowen; Pham, Tuan H.; Wu, Qing

doi:10.1007/s00198-020-05623-6

Cited by 16 publications

(8 citation statements)

References 41 publications

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“…In the future, novel biochemical markers such as high sensitivity CRP (hs-CRP) may be useful: in a recent meta-analysis of 10 studies, the RR for fracture in a comparison of the top third group to the bottom third group of hs-CRP was 1.54 (1.18–2.01), though these findings cannot be applied to an individual patient [ 100 ]. Similarly, uric acid has been shown to be predictive of fracture, with an increased serum uric acid level associated with a lower risk of fracture [ 101 ].…”

Section: Bone Turnover Markers In Treatment Stratificationmentioning

confidence: 99%

Management of patients at very high risk of osteoporotic fractures through sequential treatments

et al. 2022

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Osteoporosis care has evolved markedly over the last 50 years, such that there are now an established clinical definition, validated methods of fracture risk assessment and a range of effective pharmacological agents. Currently, bone-forming (anabolic) agents, in many countries, are used in those patients who have continued to lose bone mineral density (BMD), patients with multiple subsequent fractures or those who have fractured despite treatment with antiresorptive agents. However, head-to-head data suggest that anabolic agents have greater rapidity and efficacy for fracture risk reduction than do antiresorptive therapies. The European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO) convened an expert working group to discuss the tools available to identify patients at high risk of fracture, review the evidence for the use of anabolic agents as the initial intervention in patients at highest risk of fracture and consider the sequence of therapy following their use. This position paper sets out the findings of the group and the consequent recommendations. The key conclusion is that the current evidence base supports an “anabolic first” approach in patients found to be at very high risk of fracture, followed by maintenance therapy using an antiresorptive agent, and with the subsequent need for antiosteoporosis therapy addressed over a lifetime horizon.

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Section: Bone Turnover Markers In Treatment Stratificationmentioning

confidence: 99%

Management of patients at very high risk of osteoporotic fractures through sequential treatments

et al. 2022

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“…In addition, several studies have reported that subclinical inflammation and poor nutritional status are involved in the development of OP and fractures ( 11 ). Many inflammatory markers such as C-reactive protein (CRP) and tumor necrosis factor α, could stimulate osteoclast activity, leading to increased bone resorption and bone loss ( 12 , 13 ). Albumin is an indicator of nutritional status and plays an important role in maintaining bone health ( 14 ).…”

Section: Introductionmentioning

confidence: 99%

High C-reactive protein-to-albumin ratio levels are associated with osteoporosis in patients with primary biliary cholangitis

Li,

Liu,

2024

Front. Endocrinol.

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ObjectiveInflammation contributes to the development of metabolic bone diseases. The C-reactive protein-to-albumin ratio (CAR) is an inflammation-based marker with a prognostic value for several metabolic diseases. This study investigated the relationship between the CAR and osteoporosis (OP) in patients with primary biliary cholangitis (PBC).MethodsPatients with PBC treated at Beijing Ditan Hospital between January 2018 and June 2023 were enrolled. Logistic regression analysis was performed to investigate the factors influencing OP. The predictive value of CAR for OP was evaluated using receiver operating characteristic (ROC) curves. Moreover, a restricted cubic spline (RCS) fitted with a logistic regression model was used to analyze the relationship between CAR and OP.ResultsThe prevalence of OP among the patients with PBC was 26.9% (n = 82). CAR levels were higher in the OP group than in the non-OP group (0.33 (0.09, 0.61) vs. 0.08 (0.04, 0.18), P < 0.001). Logistic regression analysis showed that CAR was an independent predictor of OP in patients with PBC (odds ratio = 2.642, 95% confidence interval = 1.537-4.540, P < 0.001). CAR exhibited a good predictive ability for OP, with an areas under the curve (AUC) of 0.741. We found that individuals with CAR values > 0.1 have higher odds of OP. In addition, high CAR levels were associated with an increased prevalence of fragility fractures and high 10-year fracture risk.ConclusionHigh CAR levels were associated with greater odds of developing OP, and the CAR could serve as an independent predictor of OP in patients with PBC.

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“…In a meta-analysis on studies investigating the relationship of hsCRP and fracture risk, Mun et al . report risk ratios of 1.54–1.57 for individuals with the highest tertile of hsCRP [ 10 ]. Mun and colleague’s conclusion supports the general view of hsCRP as a predictor of fracture risk.…”

Section: Introductionmentioning

confidence: 99%

Serum high sensitivity C-reactive protein poorly predicts bone mineral density: A NHANES 2017–2020 analysis

Little-Letsinger

2023

PLoS ONE

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A reliable, widely available method to detect osteoporosis prior to fracture is needed. Serum levels of C-reactive protein may independently predict low bone mineral density (BMD) and high fracture risk. Existing empirical data focus on sexually and/or racially homogenous populations. This study tests the hypotheses that: C-reactive protein (1) negatively correlates with BMD and (2) fracture history, and (3) independently predicts BMD and fracture history in a diverse population. NHANES 2017–2020 pre-pandemic cycle data were analyzed in R studio. Strength and direction of relationships (-1 to +1) between variables were determined using Kendall’s rank correlation coefficient (τ). Linear models were optimized to predict femoral neck or lumbar spine BMD. C-reactive protein positively correlated with femoral (τ = 0.09, p<0.0001) and spine BMD (τ = 0.10, p<0.0001). Individuals identifying as female demonstrated more robust, but still weak, correlations between C-reactive protein and femoral neck (τ = 0.15, p<0.0001; male, τ = 0.06, p = 0.051) and spine BMD (τ = 0.16, p<0.0001; male, τ = 0.06, p = 0.04). C-reactive protein positively correlated with fracture history (τ = 0.083, p = 0.0009). C-reactive protein significantly predicted femoral neck (R2 = 0.022, p = 0.0001) and spine BMD (R2 = 0.028, p<0.0001) and fracture history (R2 = 0.015, p<0.0001). Exploratory analyses identified weight was the single best predictor for femoral neck (R2 = 0.24, p<0.0001) and spine BMD (R2 = 0.21, p<0.0001). In sum, C-reactive protein statistically correlates with and predicts femoral neck and spine BMD, but the magnitude is too low to be biologically meaningful. While weight is a more robust predictor, individuals who are overweight or obese account for nearly half of all osteoporotic fractures, limiting the predictive power of this variable at identifying individuals at risk for osteoporosis. Identification of a robust predictor of fracture risk in a diverse population and across of range of body weights and compositions is needed.

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C-reactive protein and fracture risk: an updated systematic review and meta-analysis of cohort studies through the use of both frequentist and Bayesian approaches

Cited by 16 publications

References 41 publications

Management of patients at very high risk of osteoporotic fractures through sequential treatments

Management of patients at very high risk of osteoporotic fractures through sequential treatments

High C-reactive protein-to-albumin ratio levels are associated with osteoporosis in patients with primary biliary cholangitis

Serum high sensitivity C-reactive protein poorly predicts bone mineral density: A NHANES 2017–2020 analysis

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