Session Type: Abstract Submissions (ACR)
Background/Purpose: Previous studies have shown a relationship between osteoporosis and increased risk of death. Moreover, secondary hyperparathyroidism has been linked to mortality amongst frail older hip fractures patients. However, none of these studies performed a concomitant evaluation of the parathormone(PTH)-calcium-vitamin D-axis and bone mass, and this is essential to determine more accurately the contribution of each of these parameters to survival in community-dwelling older subjects. The aim of this study was, therefore, to investigate the association between serum PTH status, calcium, vitamin D and bone mineral density (BMD) and all-cause mortality during a 5-year period in a community-dwelling older population.
Methods: 739 community-dwelling subjects (446 women and 293 men), aged over 65 years, were prospectively studied. Clinical data (including history of non-vertebral fractures and cardiovascular events as previous myocardial infarction, instable angina, stroke) were assessed by specific questionnaire. Serum 25(OH)D level, intact PTH, total calcium, phosphorus, creatinine, and alkaline phosphatase were also measured. BMD of the lumbar spine and hip were evaluated by DXA. Spine X-ray (T4-L4) was performed to identify vertebral fractures by the semiquantitative method. All analysis was done at baseline and after a 5-year period. Mortality was recorded during 5-year follow-up. Multivariate Cox regression analysis was used to compute hazard ratios for all-cause mortality.
Results: After 5-year follow-up, there were 104 (14.1%) deaths. Comparing with individuals who were alive at the end of follow-up, subjects who died were older (75.9±6.8 vs. 72.6±4.8 years, P<0.001), had lower weight (64.4±15 vs. 67.6±13.1 kg, P=0.03), lower glomerular filtration rate (GFR) (52.3±25.3 vs. 59.0 ±18.4 ml/min, P<0.001), higher PTH level (45.8±23.2 vs. 38.1±16.0 pg/dl, P=0.003) and lower 25(OH)D level (17.8±10.4 vs. 20.2±10.2 ng/ml, P=0.005). There was also difference between the groups (deceased vs. alive) related to frequency of diabetes mellitus (36.5 vs. 19.1%, P<0.001), prevalence of any cardiovascular event (26.0 vs. 13.1%, P=0.001) and low BMD (T-score ≤ -2: 74.0 vs. 61.3%, P=0.01). After adjustments for age, sex and GFR, low BMD (HR:1.80 95% CI:1.1–2.9, P=0.02), PTH level (HR:1.12 95% CI:1.01-1.23, P=0.003), diabetes mellitus (HR:2.77 95% CI:1.71-4.50, P<0.001) and any cardiovascular event (HR:1.97 95% CI:1.16-3.36, P=0.01) remained independently associated to all-cause mortality.
Conclusion: Low BMD and higher PTH level, but not vitamin D per se, were significantly associated with mortality in community-dwelling older adults. These findings support the notion that a careful screening of these bone parameters might improve the outcomes of elderly population.
D. S. Domiciano,
L. G. Machado,
J. B. Lopes,
C. P. Figueiredo,
R. M. R. Pereira,
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/low-bone-mineral-density-and-higher-parathyroid-hormone-levels-as-independent-factors-to-all-cause-mortality-in-community-dwelling-older-adults-the-sao-paulo-ageing-health-study-spah/