Iron Deficiency Anemia as a Risk Factor for Osteoporosis in Taiwan: A Nationwide Population-Based Study

Pan, Mei Lien; Chen, Li Ru; Tsao, Hsiao Mei; Chen, Kuo Hu

doi:10.3390/nu9060616

Cited by 49 publications

(31 citation statements)

References 24 publications

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“…One of the limitations of the study was that subjects with hormone replacement, osteoporosis treatment or hysterectomy were excluded. Pan et al (2017) reported similar findings on the association between IDA and osteoporosis in the general population but their results were not gender specific. Also, in Harris et al (2003 reported that the dietary intake of iron is positively associated with mineral bone density in postmenopausal woman aged between 44 and 66 years.…”

Section: Accepted Manuscriptsupporting

confidence: 54%

Iron status in the elderly: A review of recent evidence

Wawer

Jennings

Fairweather‐Tait

2018

Mechanisms of Ageing and Development

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A comprehensive literature review of iron status in the elderly was undertaken in order to update a previous review (Fairweather-Tait et al, 2014); 138 summarised papers describe research on the magnitude of the problem, aetiology and age-related physiological changes that may affect iron status, novel strategies for assessing iron status with concurrent health conditions, hepcidin, lifestyle factors, iron supplements, iron status and health outcomes (bone mineral density, frailty, inflammatory bowel disease, kidney failure, cancer, cardiovascular, and neurodegenerative diseases). Each section of this review concludes with key points from the relevant papers. The overall findings were that disturbed iron metabolism plays a major role in a large number of conditions associated with old age. Correction of iron deficiency/overload may improve disease prognosis, but diagnosis of iron deficiency requires appropriate cut-offs for biomarkers of iron status in elderly men and women to be agreed. Iron deficiency (with or without anemia), anemia of inflammation, and anemia of chronic disease are all widespread in the elderly and, once identified, should be investigated further as they are often indicative of underlying disease. Management options should be reviewed and updated, and novel therapies, which show potential for treating anemia of inflammation or chronic disease, should be considered.

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Section: Accepted Manuscriptsupporting

confidence: 54%

Iron status in the elderly: A review of recent evidence

Wawer

Jennings

Fairweather‐Tait

2018

Mechanisms of Ageing and Development

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“…Our results are in line with numerous evidences of multidirectional (patho)physiological links between the skeleton as a dynamic, metabolically active organ and the cardiovascular, renal, liver, endocrine, nervous and immune systems. Our observations complement the results from many previous studies showing positive bi- and multi-directional relationships between osteoporosis, falls and fractures, on one hand, and chronic conditions such as CKD 71 , 85 - 90 , CVDs 91 - 104 , anaemia 105 - 111 , hypoalbuminaemia 112 - 114 and hyperthyroidism 115 - 119 on the other, supporting the concept that osteoporosis is a systemic disease.…”

Section: Discussionsupporting

confidence: 89%

Bone Turnover Status: Classification Model and Clinical Implications

Fisher¹,

Fisher²,

Srikusalanukul³

et al. 2018

Int. J. Med. Sci.

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Aim: To develop a practical model for classification bone turnover status and evaluate its clinical usefulness.Methods: Our classification of bone turnover status is based on internationally recommended biomarkers of both bone formation (N-terminal propeptide of type1 procollagen, P1NP) and bone resorption (beta C-terminal cross-linked telopeptide of type I collagen, bCTX), using the cutoffs proposed as therapeutic targets. The relationships between turnover subtypes and clinical characteristic were assessed in1223 hospitalised orthogeriatric patients (846 women, 377 men; mean age 78.1±9.50 years): 451(36.9%) subjects with hip fracture (HF), 396(32.4%) with other non-vertebral (non-HF) fractures (HF) and 376 (30.7%) patients without fractures.Resalts: Six subtypes of bone turnover status were identified: 1 - normal turnover (P1NP>32 μg/L, bCTX≤0.250 μg/L and P1NP/bCTX>100.0[(median value]); 2- low bone formation (P1NP ≤32 μg/L), normal bone resorption (bCTX≤0.250 μg/L) and P1NP/bCTX>100.0 (subtype2A) or P1NP/bCTX<100.0 (subtype 2B); 3- low bone formation, high bone resorption (bCTX>0.250 μg/L) and P1NP/bCTX<100.0; 4- high bone turnover (both markers elevated ) and P1NP/bCTX>100.0 (subtype 4A) or P1NP/bCTX<100.0 (subtype 4B). Compared to subtypes 1 and 2A, subtype 2B was strongly associated with nonvertebral fractures (odds ratio [OR] 2.0), especially HF (OR 3.2), age>75 years and hyperparathyroidism. Hypoalbuminaemia and not using osteoporotic therapy were two independent indicators common for subtypes 3, 4A and 4B; these three subtypes were associated with in-hospital mortality. Subtype 3 was associated with fractures (OR 1.7, for HF OR 2.4), age>75 years, chronic heart failure (CHF), anaemia, and history of malignancy, and predicted post-operative myocardial injury, high inflammatory response and length of hospital stay (LOS) above10 days. Subtype 4A was associated with chronic kidney disease (CKD), anaemia, history of malignancy and walking aids use and predicted LOS>20 days, but was not discriminative for fractures. Subtype 4B was associated with fractures (OR 2.1, for HF OR 2.5), age>75 years, CKD and indicated risks of myocardial injury, high inflammatory response and LOS>10 days.Conclusions: We proposed a classification model of bone turnover status and demonstrated that in orthogeriatric patients altered subtypes are closely related to presence of nonvertebral fractures, comorbidities and poorer in-hospital outcomes. However, further research is needed to establish optimal cut points of various biomarkers and improve the classification model.

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“…First, anemia itself is related to low bone density. A large cohort study in Taiwan reported that the risk of osteoporosis was significantly higher in subjects with iron‐deficient anemia (IDA) than in those without IDA . The MROS study found that bone mineral density (BMD) loss over time was associated with anemia .…”

Section: Discussionmentioning

confidence: 99%

Anemia and Risk of Fractures in Older Korean Adults: A Nationwide Population-Based Study

Lee

Shin

Yoo

et al. 2019

Journal of Bone and Mineral Research

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Anemia is a common health problem in older adults and is associated with risk factors for fracture such as low physical function and low bone mass. The aim of this study was to examine the relationship between anemia and fracture risk in older adults. We conducted a retrospective cohort study from 2003 to 2013. The participants were community-dwelling Korean adults aged 65 years and older who participated in the National Health Screening Program (n ¼ 72,131) between 2003 and 2008. Anemia (<12 g/dL for women and <13 g/dL for men) and severity of anemia (mild: 11 g/dL Hb < 12 g/dL; moderate to severe: Hb < 11 g/dL) were defined by World Health Organization (WHO) criteria. The incidence of any fractures, vertebral fractures, and femur fractures was identified using ICD-10 codes. Cox proportional hazard regression models were used to assess risk of fracture according to anemia. Anemia was associated with increased risk of fracture in men (any: adjusted hazard ratio [aHR] ¼ 1.29, 95% confidence interval [CI] 1.18-1.41; vertebral: aHR ¼ 1.20, 95% CI 1.03-1.40; femur: aHR ¼ 1.71, 95% CI 1.44-2.04), and less strongly but still significantly in women (any: aHR ¼ 1.10, 95% CI 1.11-1.41; vertebral: aHR ¼ 1.11, 95% CI 1.03-1.20; femur: aHR ¼ 1.37, 95% CI 1.25-1.52). Higher risk was observed in subjects with moderate-to-severe anemia in both sexes. Considering the high prevalence of anemia in older adults, it is important that health professionals recognize increased fracture risk in older adults with anemia.

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Iron Deficiency Anemia as a Risk Factor for Osteoporosis in Taiwan: A Nationwide Population-Based Study

Cited by 49 publications

References 24 publications

Iron status in the elderly: A review of recent evidence

Iron status in the elderly: A review of recent evidence

Bone Turnover Status: Classification Model and Clinical Implications

Anemia and Risk of Fractures in Older Korean Adults: A Nationwide Population-Based Study

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