Red cell distribution width is a risk factor for hip fracture in elderly men without anemia

Kim, Kyoung Min; Lui, Li‐Yung; Cauley, Jane A.; Ensrud, Kristine E.; Orwoll, Eric S.; Schousboe, John T.; Cummings, Steven R.

Affiliations

¹San Francisco Coordinating Center, California Pacific Medical Center Research Institute, San Francisco, CA, USA

²Department of Endocrinology and Metabolism, Seoul National University Bundang Hospital and Seoul National University College of Medicine, Seongnam, South Korea

³Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA

⁴Center for Chronic Disease Outcomes Research, Veterans Affairs Health Care System, Department of Medicine, University of Minnesota, Minneapolis, MN, USA

⁵Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA

⁶Oregon Health & Science University, Portland, OR, USA

⁷Park Nicollet Clinic and HealthPartners Institute, Bloomington, MN, USA

⁸University of Minnesota, Minneapolis, MN, USA

⁹Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA

Abstract and keywords

Red cell distribution width (RDW), routinely assessed as a component of a complete blood count (CBC), quantifies the variation in the size of red blood cells. It increases with age, and increased RDW predicts many aging‐related diseases and mortality. However, whether it also predicts hip fracture is unknown. We prospectively evaluated the association between RDW and hip fracture using data from the Osteoporotic Fracture in Men (MrOS) study. RDW was measured in 3635 men (aged 71 to 99 years) along with bone mineral density (BMD) in MrOS. RDW ranged from 11.3% to 32.9% (median 14.0%; interquartile range 13.5% to 14.8%) and was categorized into four groups (≤13.0%, 13.1% to 14.0%, 14.1% to 15.0%, ≥15.1%). Study participants with a hemoglobin level <13.0 g/dL were classified as having anemia. During an average 8.1 years, 164 men suffered hip fractures. The risks of hip fractures increased with increase of RDW category. Furthermore, there was a significant interaction between anemia and RDW: An association between RDW and hip fractures was only observed in participants without anemia. In those without anemia, the relative hazard of hip fractures increased with increases in RDW category: Men in the highest RDW category had a 2.8 times higher risk of hip fractures than men in the lowest group (95% confidence interval 1.1 to 7.1). The risks of all‐clinical fractures were also increased along with higher RDW values. Additionally, RDW was significantly associated with the risk of having a fall but not with femoral neck or total hip BMD. In conclusion, RDW and anemia defined by hemoglobin are widely available routine laboratory measurements that together could indicate increased risk of hip fracture, reflecting the neuromuscular effects of aging rather than lower hip BMD.

Keywords: AGING; ANEMIA; HIP FRACTURE; OSTEOPOROSIS; RED CELL DISTRIBUTION WIDTH

Links

DOI: 10.1002/jbmr.3963

PubMed: 31991005

WoS: 000520527100001

History

Received: 2019-10-7

Revised: 2020-01-10

Accepted: 2020-01-19

Online: 2020-03-19

Cited Works (1)

Year	Entry
2005	Orwoll E, Blank JB, Barrett-Connor E, Cauley J, Cummings S, Ensrud K, Lewis C, Cawthon PM, Marcus R, Marshall LM, McGowan J, Phipps K, Sherman S, Stefanick ML, Stone K. Design and baseline characteristics of the osteoporotic fractures in men (MrOS) study: a large observational study of the determinants of fracture in older men. Contemp Clin Trials. October 2005;26(5):569-585.

Cited By (2)

Year	Entry
2021	Bedel C, Korkut M. Red cell distribution width and hip fracture. J Bone Miner Res. June 2021;36(6):1202-1202.
2021	Kim KM, Lui L-Y, Cauley JA, Ensrud KE, Orwoll ES, Schousboe JT, Cummings SR; Osteoporotic Fractures in Men (MrOS) Study Research Group. Response to "Red cell distribution width is a risk factor for hip fracture in elderly men without anemia". J Bone Miner Res. June 2021;36(6):1203-1203.