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J Am Geriatr Soc. 2008 Aug;56(8):1434-41. doi: 10.1111/j.1532-5415.2008.01807.x. Epub 2008 Jul 24.

Cystatin-C, renal function, and incidence of hip fracture in postmenopausal women.

Author information

1
Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington 98109-1024, USA. alacroix@whi.org

Abstract

OBJECTIVES:

To evaluate the association between chronic kidney disease and incident hip fracture using serum cystatin-C as a biomarker of renal function calculated without reference to muscle mass.

DESIGN:

Case-control study nested within a prospective study.

SETTING:

The Women's Health Initiative Observational Study conducted at 40 U.S. clinical centers.

PARTICIPANTS:

From 93,676 women aged 50 to 79 followed for an average of 7 years, 397 incident hip fracture cases and 397 matched controls were studied.

MEASUREMENTS:

Cystatin-C levels were measured on baseline serum using a particle-enhanced immunonepholometric assay. Estimated glomerular filtration rates (eGFR(cys-c)) were calculated using a validated equation and categorized into three groups (>or=90.0 mL/min per 1.73 m(2), 60.0-89.9 mL/min per 1.73 m(2), and <60.0 mL/min per 1.73 m(2) indicating chronic kidney disease Stages 3 to 4).

RESULTS:

The odds ratio (OR) for hip fracture was 2.50 (95% confidence interval (CI)=1.32-4.72) for eGFR(cys-c) less than 60 mL/min per 1.73 m(2) compared with Stages 0 to 1, after adjustment for body mass, parental hip fracture, smoking, alcohol consumption, and physical function. No association was observed for eGFR(cys-c) of 60 to 90 mL/min per 1.73 m(2) (OR=1.04, 95% CI=0.66-1.64). Additional adjustment for poor health status, hemoglobin, serum 25-hydroxy vitamin D, and bone metabolism markers did not affect these associations. Adjustment for plasma homocysteine reduced the OR for eGFR(cys-c) less than 60 mL/min per 1.73 m(2) to 1.83 (95% CI=0.93-3.61).

CONCLUSION:

Women with eGFR(cys-c) levels less than 60 mL/min per 1.73 m(2) have a substantially greater risk of hip fracture. Effects of renal function on homocysteine levels may partially mediate, or accompany, this association.

PMID:
18662213
PMCID:
PMC2891241
DOI:
10.1111/j.1532-5415.2008.01807.x
[Indexed for MEDLINE]
Free PMC Article

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