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C-reactive protein, bone loss, fracture, and mortality in elderly women: a longitudinal study in the OPRA cohort

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Abstract

Summary

This longitudinal study investigates the association between C-reactive protein (CRP), osteoporosis, fractures, and mortality in 1044 elderly women. CRP was not an indicator for low bone mineral density (BMD), bone loss, or fracture in elderly women; however, women with elevated CRP levels over a prolonged period lost more bone over the 10-year follow-up, although fracture risk was not increased.

Introduction

Inflammation may contribute to the pathophysiology underlying impaired bone metabolism. This study investigates the association between CRP, BMD, bone loss, fracture risk, and mortality in women aged 75 and above.

Methods

This longitudinal study is based on 1044 women, all age 75 at inclusion, reassessed at ages 80 and 85, with a mean follow-up time of 11.6 years (maximum 16.9 years).

Results

Women in the lowest CRP quartile (mean 0.63 mg/L) had lower BMD compared to those in the highest CRP quartile (mean 5.74 mg/L) at total hip (TH) (0.809 vs. 0.871 g/cm2, p < 0.001) and femoral neck (FN) (0.737 vs. 0.778 g/cm2, p = 0.007). A single measurement of CRP was not associated with bone loss; however, women with persistently elevated CRP, i.e., ≥3 mg/L at ages 75 and 80 had significantly higher bone loss compared to women with CRP <3 mg/L (TH −0.125 vs. −0.085 g/cm2, p = 0.018 and FN −0.127 vs. −0.078 g/cm2, p = 0.005) during 10 years of follow-up. Women in the highest CRP quartile had a lower risk of osteoporotic fractures (hazard ratios (HR) 0.76 (95 % confidence intervals (CI) 0.52–0.98)) compared to those in the lowest, even after adjusting for weight and BMD. Mortality risk was only increased among women with the highest CRP levels.

Conclusion

CRP was not an indicator for low BMD, bone loss, or fracture in elderly women in this study. Persistently elevated CRP however seemed to be detrimental to bone health and may be associated with a higher rate of bone loss. Only the highest CRP levels were associated with mortality.

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Acknowledgments

Thanks are extended to the research nurses at the Clinical and Molecular Osteoporosis Research Unit, Malmö, Åsa Almgren and Siv Braun for data management, Dr Håkan Lovkvist for statistical advice, and to all the women who kindly participated in the study.

This work was supported by grants from the Swedish Research Council (K2012-52X-14691-10-3), FAS (2007-2125), Greta and Johan Kock Foundation, A. Påhlsson Foundation, A. Osterlund Foundation, the H. Järnhardt foundation, King Gustav V and Queen Victoria Foundation, Åke Wiberg Foundation, Thelma Zoegas Foundation, The Swedish Rheumatism Association, Skåne University Hospital Research Fund, and the Research and Development Council of Region Skåne, Sweden.

The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Conflicts of interest

Sofia Berglundh, Linnea Malmgren, Holger Luthman, Fiona McGuigan, and Kristina Åkesson declare that they have no conflict of interest.

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Authors and Affiliations

  1. Clinical and Molecular Osteoporosis Research Unit, Malmö, Sweden

    S. Berglundh, L. Malmgren, F. McGuigan & K. Åkesson

  2. Genetic Epidemiology, Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden

    H. Luthman

  3. Department of Orthopaedics, Skåne University Hospital, 205 02, Malmö, Sweden

    K. Åkesson

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  1. S. Berglundh
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  2. L. Malmgren
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Correspondence to K. Åkesson.

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Berglundh, S., Malmgren, L., Luthman, H. et al. C-reactive protein, bone loss, fracture, and mortality in elderly women: a longitudinal study in the OPRA cohort. Osteoporos Int 26, 727–735 (2015). https://doi.org/10.1007/s00198-014-2951-7

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  • DOI: https://doi.org/10.1007/s00198-014-2951-7

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