Abstract | BACKGROUND AND OBJECTIVES: The microvascular circulation plays an important role in bone health. This study examines whether albuminuria, a marker of renal microvascular disease, is associated with incident hip and pelvic fractures. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: This study reanalyzed data from the Ongoing Telmisartan Alone and in combination with Ramipril Global End Point Trial/ Telmisartan Randomized Assessment Study in Angiotensin-Converting Enzyme Intolerant Subjects with Cardiovascular Disease trials, which examined the impact of renin angiotensin system blockade on cardiovascular outcomes (n=28,601). Albuminuria was defined as an albumin-to- creatinine ratio≥30 mg/g (n=4597). Cox proportional hazards models were used to determine the association of albuminuria with fracture risk adjusted for known risk factors for fractures, estimated GFR, and rapid decline in estimated GFR (≥5%/yr). RESULTS: There were 276 hip and pelvic fractures during a mean of 4.6 years of follow-up. Participants with baseline albuminuria had a significantly increased risk of fracture compared with participants without albuminuria (unadjusted hazard ratio=1.62 [1.22, 2.15], P<0.001; adjusted hazard ratio=1.36 [1.01, 1.84], P=0.05). A dose-dependent relationship was observed, with macroalbuminuria having a large fracture risk (unadjusted hazard ratio=2.01 [1.21, 3.35], P=0.007; adjusted hazard ratio=1.71 [1.007, 2.91], P=0.05) and microalbuminuria associating with borderline or no statistical significance (unadjusted hazard ratio=1.52 [1.10, 2.09], P=0.01; adjusted hazard ratio=1.28 [0.92, 1.78], P=0.15). Estimated GFR was not a predictor of fracture in any model, but rapid loss of estimated GFR over the first 2 years of follow-up predicted subsequent fracture (adjusted hazard ratio=1.47 [1.05, 2.04], P=0.02). CONCLUSIONS:
Albuminuria, especially macroalbuminuria, and rapid decline of estimated GFR predict hip and pelvic fractures. These findings support a theoretical model of a relationship between underlying causes of microalbuminuria and bone disease.
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Authors | Joshua I Barzilay, Peggy Gao, Catherine M Clase, Andrew Mente, Johannes F E Mann, Peter Sleight, Salim Yusuf, Koon K Teo, OnTARGET/TRANSCEND Investigators |
Journal | Clinical journal of the American Society of Nephrology : CJASN
(Clin J Am Soc Nephrol)
Vol. 8
Issue 2
Pg. 233-40
(Feb 2013)
ISSN: 1555-905X [Electronic] United States |
PMID | 23184565
(Publication Type: Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)
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Chemical References |
- Angiotensin-Converting Enzyme Inhibitors
- Benzimidazoles
- Benzoates
- Ramipril
- Telmisartan
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Topics |
- Albuminuria
(complications, physiopathology)
- Angiotensin-Converting Enzyme Inhibitors
(therapeutic use)
- Benzimidazoles
(therapeutic use)
- Benzoates
(therapeutic use)
- Cardiovascular Diseases
(complications, drug therapy)
- Fractures, Bone
(epidemiology, etiology)
- Glomerular Filtration Rate
- Hip Fractures
(epidemiology, etiology)
- Humans
- Pelvic Bones
(injuries)
- Prospective Studies
- Ramipril
(therapeutic use)
- Risk Factors
- Telmisartan
- Time Factors
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