Reply to: Comments on “Association between subjective physical function and occurrence of new fractures in older adults: A retrospective cohort study”

Abstract

levels than those without chronic kidney disease. 2 In contrast, higher glycated hemoglobin levels can precipitate a more rapid decline in kidney function irrespective of baseline chronic kidney disease or diabetes status. 3 Lower grip strength frequently coexists with sarcopenia, leading to low serum creatinine levels and deviations in eGFR levels. In the work by Nakanishi et al., patients with the highest grip strength had significantly lower age and numerically the highest eGFR levels (Table 1 1 ), but it remains unclear whether patients without and with well controlled glycated hemoglobin had different eGFR. Furthermore, only age, sex and the number of antidiabetic medications were incorporated into multiple logistic regression analyses. Therefore, it is recommended to adjust for kidney function to exclude such influences.Second, glycated hemoglobin levels are also affected by baseline hemoglobin values. Because older adults constitute a significant proportion of patients diagnosed with hematologic disorders, 4 the probability of having aberrant hemoglobin values cannot be dismissed in the study population. Changes in hemoglobin levels can lead to alterations in glycated hemoglobin data, obscuring the results obtained. This issue also needs to be taken into consideration before reaching conclusions.