TY - JOUR
T1 - Serum Phosphate Is Associated With Fracture Risk
T2 - The Rotterdam Study and MrOS
AU - Campos-Obando, Natalia
AU - Koek, W. Nadia H.
AU - Hooker, Elizabeth R.
AU - van der Eerden, Bram C.J.
AU - Pols, Huibert A.
AU - Hofman, Albert
AU - van Leeuwen, Johannes P.T.M.
AU - Uitterlinden, Andre G.
AU - Nielson, Carrie M.
AU - Zillikens, M. Carola
N1 - Publisher Copyright:
© 2017 American Society for Bone and Mineral Research
PY - 2017/6
Y1 - 2017/6
N2 - Extreme phosphate levels (P) have been associated with mineralization defects and increased fracture risk. Whether P within normal range is related to bone health in the general population is not well understood. To investigate the association of P with bone mineral density (BMD) and fracture risk, we assessed two population-based cohorts: the Dutch Rotterdam Study (RS-I, RS-II, RS-III; n = 6791) and the US Osteoporotic Fractures in Men (MrOS; n = 5425) study. The relationship of P with lumbar spine (LS) and femoral neck (FN) BMD was tested in all cohorts via linear models; fracture risk was tested in RS-I, RS-II, and MrOS through Cox models, after follow-up of 8.6, 6.6, and 10.9 years, respectively. Adjustments were made for age, body mass index, smoking, serum levels of calcium, potassium, 25-hydroxyvitamin D, estimated glomerular filtration rate (eGFR), FN-BMD, prevalent diabetes, and cardiovascular disease. Additional adjustments were made for phosphate intake, parathyroid hormone, and fibroblast growth factor 23 levels in MrOS. We further stratified by eGFR. Results were pooled through study-level meta-analyses. Hazard ratios (HR) and betas (β) (from meta-analyses) are expressed per 1 mg/dL P increase. P was positively associated with fracture risk in men and women from RS, and findings were replicated in MrOS (pooled HR all [95% CI]: 1.47 [1.31–1.65]). P was associated with fracture risk in subjects without chronic kidney disease (CKD): all (1.44 [1.26–1.63]) and in men with CKD (1.93 [1.42–2.62]). P was inversely related to LS-BMD in men (β: –0.06 [–0.11 to –0.02]) and not to FN-BMD in either sex. In summary, serum P was positively related to fracture risk independently from BMD and phosphate intake after adjustments for potential confounders. P and LS-BMD were negatively related in men. Our findings suggest that increased P levels even within normal range might be deleterious for bone health in the normal population.
AB - Extreme phosphate levels (P) have been associated with mineralization defects and increased fracture risk. Whether P within normal range is related to bone health in the general population is not well understood. To investigate the association of P with bone mineral density (BMD) and fracture risk, we assessed two population-based cohorts: the Dutch Rotterdam Study (RS-I, RS-II, RS-III; n = 6791) and the US Osteoporotic Fractures in Men (MrOS; n = 5425) study. The relationship of P with lumbar spine (LS) and femoral neck (FN) BMD was tested in all cohorts via linear models; fracture risk was tested in RS-I, RS-II, and MrOS through Cox models, after follow-up of 8.6, 6.6, and 10.9 years, respectively. Adjustments were made for age, body mass index, smoking, serum levels of calcium, potassium, 25-hydroxyvitamin D, estimated glomerular filtration rate (eGFR), FN-BMD, prevalent diabetes, and cardiovascular disease. Additional adjustments were made for phosphate intake, parathyroid hormone, and fibroblast growth factor 23 levels in MrOS. We further stratified by eGFR. Results were pooled through study-level meta-analyses. Hazard ratios (HR) and betas (β) (from meta-analyses) are expressed per 1 mg/dL P increase. P was positively associated with fracture risk in men and women from RS, and findings were replicated in MrOS (pooled HR all [95% CI]: 1.47 [1.31–1.65]). P was associated with fracture risk in subjects without chronic kidney disease (CKD): all (1.44 [1.26–1.63]) and in men with CKD (1.93 [1.42–2.62]). P was inversely related to LS-BMD in men (β: –0.06 [–0.11 to –0.02]) and not to FN-BMD in either sex. In summary, serum P was positively related to fracture risk independently from BMD and phosphate intake after adjustments for potential confounders. P and LS-BMD were negatively related in men. Our findings suggest that increased P levels even within normal range might be deleterious for bone health in the normal population.
KW - 25-HYDROXYVITAMIN D
KW - BMD
KW - CALCIUM
KW - FRACTURES
KW - PHOSPHATE LEVELS
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U2 - 10.1002/jbmr.3094
DO - 10.1002/jbmr.3094
M3 - Article
C2 - 28177140
AN - SCOPUS:85017140464
SN - 0884-0431
VL - 32
SP - 1182
EP - 1193
JO - Journal of Bone and Mineral Research
JF - Journal of Bone and Mineral Research
IS - 6
ER -