Older Men With Anemia Have Increased Fracture Risk Independent of Bone Mineral Density.

Context: Extremely low hemoglobin (Hgb) values have been linked to increased fracture risk at different sites. However, careful assessment of clinically defined anemia and fracture risk is lacking. Objective: To determine whether men with anemia were at increased risk of fracture after accounting for bone mineral density (BMD) and bone loss.

Design: Cross-sectional analysis (at visit 3) and prospective analysis (from baseline to visit 3) in the Osteoporotic Fractures in Men (MrOS), a multisite, longitudinal cohort study. Setting: Six communities in the United States. Participants: A total of 3632 community-dwelling men (age ≥65 years) in MrOS at baseline (2000 through 2002) who were able to walk unassisted, did not have hip replacement or fracture, and had complete blood cell counts at visit 3 (2007 through 2009). Outcomes: Adjudicated spine and nonspine fractures during a median 7.2 years of follow-up.

Results: Analytic baseline characteristics associated with fractures or anemia (defined as Hgb <12 g/dL) were included in multivariable models. Anemia was associated with increased risk of any fracture [hazard ratio (HR), 1.67; 95% confidence interval (CI), 1.26 to 2.21] and nonspine fracture (HR, 1.70; 95% CI, 1.25 to 2.31). A model including change in BMD slightly attenuated the association with any (HR, 1.60; 95% CI, 1.20 to 2.13) and nonspine fractures (HR, 1.57; 95% CI, 1.14 to 2.15). Including absolute BMD did not significantly alter the anemia-fracture association. Anemia was not associated with spine fracture.

Conclusions: Community-dwelling older men with anemia had a 57% to 72% increase in nonspine fracture risk independent of BMD and bone loss.