![]() ![]() ![]() ( 4 5) However, it is uncertain whether this association persists after adjustment for hip bone mineral density (BMD) and how this association compares with that between conventional measures of renal function and hip fracture. ( 3) Previous prospective studies have reported an association between higher serum cystatin C and an increased risk of hip fracture among postmenopausal women. ![]() ( 2) Serum cystatin C, a low molecular weight protein whose concentration is mainly determined by glomerular filtration, has been proposed to be a promising marker of kidney function that may be superior to standard creatinine-based measures in detecting mild to moderate renal dysfunction in older adults. Older age and female gender are associated with a higher prevalence of renal dysfunction ( 1) and an increased risk of osteoporosis and related fractures, including hip fractures. These findings suggest that cystatin C may be a promising biomarker for identification of older adults at high risk of hip fracture. Older women with higher cystatin C, but not higher serum creatinine or lower eGFR Cr, have an increased risk of hip fracture independent of traditional risk factors. In contrast, neither serum creatinine nor creatinine-based estimated glomerular filtration rate (eGFR Cr) were associated with risk of hip fracture. Further adjustment for additional risk factors only slightly attenuated the association the risk for hip fracture was 1.7-fold (HR 1.74, 95% CI 1.11–2.72) higher in women in quartile 4 compared with those in quartile 1. In a model adjusted for age, clinical site, body mass index and total hip BMD, higher cystatin C was associated with an increased risk of hip fracture (p for linear trend 0.008) with women in quartile 4 having a 1.9-fold higher risk (hazard ratio (HR) 1.91, 95% confidence (CI) 1.24–2.95) compared with those in quartile 1 (referent group). Serum cystatin C and creatinine were measured in Year 10 sera. To test the hypothesis that older women with higher cystatin C are at increased risk of hip fracture independent of traditional risk factors including hip bone mineral density (BMD), we performed a case-cohort analysis nested in a cohort of 4709 white women attending a Year 10 (1997–1998) examination of the Study of Osteoporotic Fractures that included a random sample of 1170 women and the first 300 women with incident hip fracture occurring after Year 10 examination. ![]()
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