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Cardiovascular biomarkers and risk of low-energy fractures among middle-aged men and women—A population-based study

Härstedt, Maria LU ; Holmberg, Anna LU ; Rogmark, Cecilia LU ; Sutton, Richard; Melander, Olle LU ; Hamrefors, Viktor LU and Fedorowski, Artur LU (2018) In PLoS ONE 13(9).
Abstract

Background: Low-energy fractures are a growing health challenge as their incidence increases with advancing age. As cardiovascular instability may be associated with higher likelihood of traumatic falls, we aimed to investigate the associations between four cardiovascular biomarkers and the risk of low-energy fractures in a middle-aged population. Methods: A total of 5291 individuals from the prospective Malmö Diet and Cancer (MDC) study (mean age, 57 years; 59% women) with data on baseline levels of four cardiovascular biomarkers: mid-regional-fragment of pro-adrenomedullin-peptide (MR-pro-ADM), mid-regional-fragment of pro-atrial-natriuretic-peptide (MR-proANP), N-terminal pro-brain natriuretic peptide (NT-pro-BNP) and... (More)

Background: Low-energy fractures are a growing health challenge as their incidence increases with advancing age. As cardiovascular instability may be associated with higher likelihood of traumatic falls, we aimed to investigate the associations between four cardiovascular biomarkers and the risk of low-energy fractures in a middle-aged population. Methods: A total of 5291 individuals from the prospective Malmö Diet and Cancer (MDC) study (mean age, 57 years; 59% women) with data on baseline levels of four cardiovascular biomarkers: mid-regional-fragment of pro-adrenomedullin-peptide (MR-pro-ADM), mid-regional-fragment of pro-atrial-natriuretic-peptide (MR-proANP), N-terminal pro-brain natriuretic peptide (NT-pro-BNP) and C-terminal-pro-arginine-vasopressin (CT-pro-AVP/Copeptin) were included. The associations between biomarker levels and first incident low-energy fracture were tested in Cox proportional-hazard models, taking potential interactions and traditional risk factors into account. Results: Participants were followed for a median time of 21.0 years, during which 1002 subjects (19%) experienced at least one low-energy fracture. Subjects with incident fracture were older, more likely to be women, had lower BMI and higher prevalence of previous fractures. Among biomarkers, there was a significant interaction between gender and MR-pro-ADM on the risk of fracture (p = 0.002). MR-pro-ADM predicted fractures in men only (hazard ratio, 1.23; 95% CI 1.09-1.40; p = 0.001), whereas there was no association among women. Levels of MR-pro-ANP, NT-pro-BNP and CT-pro-AVP did not predict fractures. Conclusions Higher circulating levels of MR-pro-ADM predict low-energy fractures among middle-agedmen, whereas levels of MR-pro-ANP, NT-pro-BNP and CT-pro-AVP are not associated with increased fracture risk. Further controlled studies should test the hypothesis whether MRpro- ADM may improve prediction of bone fractures.

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author
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published
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in
PLoS ONE
volume
13
issue
9
publisher
Public Library of Science
external identifiers
  • scopus:85053329784
ISSN
1932-6203
DOI
10.1371/journal.pone.0203692
language
English
LU publication?
yes
id
16d67e29-cb81-4bb3-a2a3-2f97f8629ec8
date added to LUP
2018-10-12 08:51:55
date last changed
2019-01-06 14:09:44
@article{16d67e29-cb81-4bb3-a2a3-2f97f8629ec8,
  abstract     = {<p>Background: Low-energy fractures are a growing health challenge as their incidence increases with advancing age. As cardiovascular instability may be associated with higher likelihood of traumatic falls, we aimed to investigate the associations between four cardiovascular biomarkers and the risk of low-energy fractures in a middle-aged population. Methods: A total of 5291 individuals from the prospective Malmö Diet and Cancer (MDC) study (mean age, 57 years; 59% women) with data on baseline levels of four cardiovascular biomarkers: mid-regional-fragment of pro-adrenomedullin-peptide (MR-pro-ADM), mid-regional-fragment of pro-atrial-natriuretic-peptide (MR-proANP), N-terminal pro-brain natriuretic peptide (NT-pro-BNP) and C-terminal-pro-arginine-vasopressin (CT-pro-AVP/Copeptin) were included. The associations between biomarker levels and first incident low-energy fracture were tested in Cox proportional-hazard models, taking potential interactions and traditional risk factors into account. Results: Participants were followed for a median time of 21.0 years, during which 1002 subjects (19%) experienced at least one low-energy fracture. Subjects with incident fracture were older, more likely to be women, had lower BMI and higher prevalence of previous fractures. Among biomarkers, there was a significant interaction between gender and MR-pro-ADM on the risk of fracture (p = 0.002). MR-pro-ADM predicted fractures in men only (hazard ratio, 1.23; 95% CI 1.09-1.40; p = 0.001), whereas there was no association among women. Levels of MR-pro-ANP, NT-pro-BNP and CT-pro-AVP did not predict fractures. Conclusions Higher circulating levels of MR-pro-ADM predict low-energy fractures among middle-agedmen, whereas levels of MR-pro-ANP, NT-pro-BNP and CT-pro-AVP are not associated with increased fracture risk. Further controlled studies should test the hypothesis whether MRpro- ADM may improve prediction of bone fractures.</p>},
  articleno    = {e0203692},
  author       = {Härstedt, Maria and Holmberg, Anna and Rogmark, Cecilia and Sutton, Richard and Melander, Olle and Hamrefors, Viktor and Fedorowski, Artur},
  issn         = {1932-6203},
  language     = {eng},
  month        = {09},
  number       = {9},
  publisher    = {Public Library of Science},
  series       = {PLoS ONE},
  title        = {Cardiovascular biomarkers and risk of low-energy fractures among middle-aged men and women—A population-based study},
  url          = {http://dx.doi.org/10.1371/journal.pone.0203692},
  volume       = {13},
  year         = {2018},
}