Association of Heel Bone Mineral Density With Incident Disability and Mortality in Community‐Dwelling Older Adults

Abstract

Age‐related bone loss is common in older adults. However, the association of low bone mass with incident disability and mortality is not well established. A sample of 738 participants in the Rush Memory and Aging Project (MAP) was evaluated at baseline for bone mineral density (BMD) using quantitative ultrasound at the calcaneus. An annual interview assessed basic activities of daily living (BADL), instrumental activities of daily living (IADL), mobility disability, and history of hip fracture. The associations between baseline BMD and risk of death; incident BADL, IADL, and mobility disability; and hip fracture were investigated using Cox hazard models, adjusting for age, sex, education, race, and body mass index (BMI). The robustness of our findings was evaluated by adjusting for confounding factors and health conditions including joint pain, musculoskeletal medications, smoking status, motor function, global cognition, falls, cardiovascular events, and diabetes. Participants were on average (mean ± SD) 80.9 ± 7.0 years old, 72% female, and 3.8% black, with a baseline BMI of 27.3 ± 5.4 kg/m2, and a baseline of BMD of 0.44 ± 0.14 g/cm2. In models adjusted for age, sex, education, race, and BMI, lower BMD was associated with a higher rate of death (hazard ratio [HR] 1.20; 95% confidence interval [CI], 1.08–1.33), incident BADL disability (HR 1.20; 95% CI, 1.05–1.37), and hip fracture (HR 2.57; 95% CI, 1.72–3.82), but not of IADL disability (HR 1.00; 95% CI, 0.85–1.17) or mobility disability (HR 1.13; 95% CI, 0.97–1.32). The association between BMD and mortality was not significant in fully adjusted models, but the BMD and BADL associations remained significant in models adjusting for both demographic variables and BMD‐modifying health conditions. BMD is associated with incident disability in older adults. © 2020 The Authors. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research.

Lifetime depression and age-related changes in body composition, cardiovascular function, grip strength and lung function: sex-specific analyses in the UK Biobank

“…The observation that fat mass was higher in females confirms findings from Sweden [ 29 ] and the US [ 26 ], although research in Chinese adults found no evidence of sex differences [ 27 ]. Males had higher heel bone mineral density, supporting previous studies of hand [ 30 ] and heel [ 31 ] bone mineral density. Our finding that arterial stiffness was higher in males supports a review which found greater arterial stiffness in males until at least age 60 [ 32 ].…”

Lifetime depression and age-related changes in body composition, cardiovascular function, grip strength and lung function: sex-specific analyses in the UK Biobank

“…The observation that fat mass was higher in females confirms findings from Sweden 42 and the US 39 , although research in Chinese adults found no evidence of sex differences 40 . Males had higher heel bone mineral density, supporting previous studies of hand 43 and heel 44 bone mineral density. Our finding that arterial stiffness was higher in males supports a review which found greater arterial stiffness in males until at least age 60 45 .…”

Inferring causal effects of homocysteine and B-vitamin concentrations on bone mineral density and fractures: Mendelian randomization analyses

“…Another cross-sectional study has suggested the higher Hcy concentrations were inversely associated with the BMD in femoral neck and lumbar spine regions ( 58 ), which gave the support that different associations between Hcy levels and body regions for our motivation. Our findings declared that elevated Hcy levels had a significant influence on decreased heel BMD through the MR study design, revealing a novel clue for reducing heel BMD loss as heel BMD has been reported to be a vital risk factor for incident disability and mortality ( 59 ). Thus, this finding has great significance for public health.…”