Importance of Albumin, 25(OH)-Vitamin D and IGFBP-3 as Risk Factors in Elderly Women and Men with Hip Fracture

Abstract

The relative importance of vitamin D deficiency, secondary hyperparathyroidism, nutritional deficiency and low bone mineral density (BMD) as risk factors for hip fracture is not definitely established. In the framework of a case-control study of risk factors for hip fractures, biochemical markers of bone metabolism and nutrition and femoral BMD data were compared in 136 female and 43 male hip fracture patients, 136 female and 44 male age-matched hospitalized controls, and 47 healthy elderly women (8 men). Patients with hip fracture had lower albumin (-10%) and 25(OH)-vitamin D (25(OH)D; -19%) compared with hospitalized controls, and lower albumin (-28%) and 25(OH)D levels (-52%) compared with the elderly controls. Serum values of IGFBP-3 were also significantly lower (-33%) in hip fracture patients than in community controls. BMD of femoral neck was lower (p < 0.001) in patients than in hospitalized and community controls. In hip fracture patients, parathyroid hormone (PTH) correlated weakly with BMD (neck: r = -0.19, trochanter: r = -0.17; both p < 0.05). When all women were pooled (n = 233), albumin correlated significantly (age-adjusted) with BMD at all sites (neck: r = 0.27, trochanter: r = 0.25; all p < 0.001). Albumin, but not 25(OH)D, also correlated with skinfold thickness (r = 0.19, p < 0.0025) and with body mass index (BMI) (r = 0.14, p < 0.05). Male patients with hip fracture had lower BMD and albumin (both p < 0.001), 25(OH)D (p = 0.02) and IGFBP-3 levels (p < 0.005) compared with the controls. When male patients and controls were pooled together, albumin, skinfold thickness and BMI were significantly correlated with each other, but not with BMD. IGFBP-3 was highly correlated with albumin (p < 0.0001), 25(OH)D (p < 0.005) and, less significantly, with PTH (p < 0.05), but not with BMI or skinfold thickness. IGFBP-3 was significantly correlated with BMD at all sites (neck: r = 0.27, p < 0.05; trochanter: r = 0.40, p < 0.0005). In conclusion, low albumin and low BMD were both important risk factors for hip fracture. Low serum albumin was the strongest independent variable correlated with hip fractures. In men. IGFBP-3 was correlated with BMD. The femoral BMD depended only weakly on PTH and 25(OH)D, but was correlated at all sites with albumin, a non-specific parameter of nutrition and general health.

Predictors of low bone mineral density in the elderly: the role of dietary intake, nutritional status and sarcopenia

“…Conflicting results have been reported on the relationship between serum albumin and BMD, however. In our earlier study, underweight hypoalbuminemic subjects had a lower T-score than underweight cases with normal serum albumin levels (Coin et al, 2000) -findings consistent with the positive correlation demonstrated by other authors in both genders (Thiebaud et al, 1997) and in women alone (Di Monaco et al, 2003). But two large cross-sectional studies failed to confirm this correlation between albumin and BMD (Lunde et al, 1998;D'Erasmo et al, 1999).…”

“…Serum albumin is a sensitive indicator of severe protein depletion and some authors use it as a measure of frailty and disability (Baumgartner et al, 1996). Serum albumin was found inversely associated with the risk of hip fracture, both in a prospective study (Thiebaud et al, 1997) and in a case-control study (Huang et al, 1996), supporting the view that severe protein depletion plays a part in causing hip fracture (Di Monaco et al, 2003). Conflicting results have been reported on the relationship between serum albumin and BMD, however.…”

Gastric banding induces negative bone remodelling in the absence of secondary hyperparathyroidism: potential role of serum C telopeptides for follow-up

“…21,22 Serum levels of the growth-hormone-dependent growth factors IGFBP-3 and IGF-1 are reduced but positively correlated to BMD in men with idiopathic osteoporosis. [23][24][25][26] Now, the distribution of cortical bone varies in the skeleton. In the lumbar spine, cortical bone comprises only about a third of the total bone content, whereas the trochanteric area contains about 50% and the femoral neck 75% of cortical bone, the remainder being cancellous bone.…”

Influence of Anabolic Steroid on Tibial Fracture Healing in Rabbits – A Study on Experimental Model

“…The functional recovery after a fracture is often incomplete, especially in the older ages. A catabolic state develops after fracture and following surgery, which contributes to a poor outcome [5][6][7][8][9].…”