Hypoalbuminemia and Osteoporosis: Reappraisal of a Controversy

Abstract

In a large population, we report an independent association of osteoporosis with lower levels of serum albumin and a longer-observed duration of hypoalbuminemia.

Biochemical Alterations in Postmenopausal Women Having Osteoporic Risk

“…They further summarized that the association between serum albumin and bone mineral density was not age dependent [35]. The serum albumin concentration in the whole population in this study was supported by Afshinnia et al's study [36]. The lower concentration of albumin in osteoporosis patients was supported by Nilsson et al's study [37].…”

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

“…The OR at the lumbar spine was relatively smaller than what was observed at hip areas, and therefore in the subgroup analysis fewer subgroups reached statistical significance due to loss of power. A press.endocrine.org/journal/jcem larger sample size at the hypoalbuminemic range is required to show the statistical significance at the lumbar area as was achieved in our previous observation (18). The smaller OR at the lumbar spine as compared to hip areas suggests that trabecular and compact bones may differentially be associated with hypoalbuminemia.…”

“…Similarly, the study of the healthy postmenopausal women defined the inclusion criteria narrowly by age, so that it eliminated the variability necessary to capture the association (14). To that end, we recently examined the association in a large cohort of patients in our health care system with sufficient gender and race diversity with an age range of 20 to over 100 years, along with adequate multivariable adjusting for potential confounders, and we found significantly higher odds of association between hypoalbuminemia and OP at the femoral neck, total hip, and lumbar spine (18). However, a limitation of our previous work (18) was that the results could not be extrapolated to the general population or other patient populations with different characteristics.…”

“…To that end, we recently examined the association in a large cohort of patients in our health care system with sufficient gender and race diversity with an age range of 20 to over 100 years, along with adequate multivariable adjusting for potential confounders, and we found significantly higher odds of association between hypoalbuminemia and OP at the femoral neck, total hip, and lumbar spine (18). However, a limitation of our previous work (18) was that the results could not be extrapolated to the general population or other patient populations with different characteristics. Therefore, a relevant question becomes whether or not what we reported as an independent association between hypoalbuminemia and OP could be replicated in independent cohorts.…”

“…In a recent study, we suggested that the controversy in human studies is due to methodological limitations including the lack of diversity of selected participants, low sample size and power of studies, and limited range in which serum albumin has been studied, besides other limitations (18). Indeed, when some of these limitations were addressed, we were able to demonstrate the independent association between hypoalbuminemia and OP in a large diverse cohort in our health care system (18). In this study, our aim is to replicate the association of hypoalbuminemia with OP at various anatomical sites in independent samples randomly selected from the U.S. general population using the National Health and Nutrition Examination Survey (NHANES).…”