Full Length ArticleBone mineral density and osteoporosis in relation to all-cause and cause-specific mortality in NHANES: A population-based cohort study
Introduction
Osteoporosis refers to a vital public health problem that is considerably and progressively prevalent in developing and developed countries [1]. In 2010, the U.S. was estimated to have 10.2 million cases of osteoporosis among population aged over 50 years; such number was expected to reach 13.5 million in 2030 [2,3]. Osteoporosis refers to a metabolic condition characterized by decreased bone mineral density (BMD) and enhanced risk of fragility fractures, capable of causing increased risk of all-cause, cardiovascular and cancer mortality [[4], [5], [6], [7]]. In fact, only less than one-third of hip and vertebral fractures resulted from low BMD and advancing age [8,9]. Low BMD was reported to be linked to the elevated risk of mortality independent of fragility fracture [[10], [11], [12]].
BMD is a critical component in osteoporosis assessment and diagnosis. Low BMD is related to multiple factors (e.g., nutrition [13], calcium metabolism [14], estrogen metabolism [15], environmental xenoestrogens [16], as well as genetic factors [17]. A systematic review and meta-analysis conducted in 2013 concluded that lower BMD displayed a correlation with the elevated risk of all-cause and cardiovascular mortality [18]. However, the involved studies in the meta-analysis and newly published studies after 2013 were primarily conducted in the elderly with a limited sample size [10,11,[19], [20], [21]]. Thus, whether low BMD can predict the risen risk of mortality in general population (aged 20 years or more) remains unclear. Moreover, the BMD level of different sites was correlated with different mortality risks [20,22]. The exploration and comparison in the relationships between BMD in different sites and mortality are required to delve into the biochemical mechanism of bone metabolism and death.
To this end, this study ascertained the relationships between BMD levels of total femur, femur neck, trochanter and intertrochanter in femur and lumbar spine with all-cause mortality, as well as the underlying causes of death (e.g., cancer and heart diseases) in a cohort representative of the U.S. adult population. Furthermore, the relationships between BMD and risk of mortality in different subgroups were also ascertained.
Section snippets
Study population
The publicly data files from the National Health and Nutrition Examination Survey (NHANES) released by the Centers for Disease Control and Prevention (CDC) were used. In brief, NHANES is an ongoing and continuous program to harvest health-related data representing the U.S. population of all ages by multistage and stratified sampling design since 1999. Recruited participants were asked to sign an informed consent and invited to complete an interviewer-administrated questionnaire; subsequently,
Description of study participants
In the analysis reported here (Fig. 1), 22,901 participants aged ≥20 years were included in continuous NHANE (2005–2010,2013–2014) datasets. Participants with missing information regarding mortality (n = 40) and other covariates (n = 5196) were excluded. Furthermore, participants who had incomplete femur status and invalid data (n = 2589) were excluded from the final model. Lastly, 15,076 aged over 20 years with complete data of interest were analyzed in this study.
During a 6.8-year median
Discussion
In the present cohort study of U.S. adults from NHANES, participants with osteoporosis in femur were identified to be correlated with higher risk of all-cause mortality and mortality of other causes. The similar association was observed in younger adults, older adults, males, and females. The study reported a statistically significantly L-shaped association for all-cause mortality with BMD increment in femur. Statistically significant L-shaped relationships were also identified for heart
Funding
This study was supported by National Natural Science Foundation of China (No. 81703289).
CRediT authorship contribution statement
Shaofang Cai:Conceptualization, Data curation, Formal analysis, Investigation, Methodology, Project administration, Writing - original draft, Writing - review & editing.Jiayao Fan:Conceptualization, Investigation, Methodology, Project administration, Writing - review & editing.Lina Zhu:Conceptualization, Investigation, Methodology, Project administration, Writing - review & editing.Jianhong Ye:Conceptualization, Project administration, Writing - review & editing.Xianming Rao:Conceptualization,
Declaration of competing interest
The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of this study.
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