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High Plasma Erythropoietin Predicts Incident Fractures in Elderly Men with Normal Renal Function: The MrOS Sweden Cohort.

Authors
  • Kristjansdottir, Hallgerdur Lind1
  • Lewerin, Catharina1
  • Lerner, Ulf H2
  • Herlitz, Hans3
  • Johansson, Peter1
  • Johansson, Helena4, 5
  • Karlsson, Magnus6
  • Lorentzon, Mattias4, 7, 8
  • Ohlsson, Claes2
  • Ljunggren, Östen9
  • Mellström, Dan2, 7, 8
  • 1 Department of Hematology and Coagulation, Sahlgrenska University Hospital and Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. , (Sweden)
  • 2 Centre for Bone and Arthritis Research, Department of Internal Medicine and Clinical Nutrition, Institute for Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. , (Sweden)
  • 3 Department of Molecular and Clinical Medicine/Nephrology, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. , (Sweden)
  • 4 McKillop Health Institute, Australian Catholic University, Melbourne, Australia. , (Australia)
  • 5 Department of Public Health and Community Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden. , (Sweden)
  • 6 Department of Orthopedics and Clinical Sciences, Lund University, Skåne University Hospital, Malmö, Sweden. , (Sweden)
  • 7 Department of Geriatric Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden. , (Sweden)
  • 8 Geriatric Medicine, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine and Clinical Nutrition, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. , (Sweden)
  • 9 Department of Medical Sciences, University of Uppsala, Uppsala, Sweden. , (Sweden)
Type
Published Article
Journal
Journal of Bone and Mineral Research
Publisher
Wiley (John Wiley & Sons)
Publication Date
Oct 18, 2019
Identifiers
DOI: 10.1002/jbmr.3900
PMID: 31626711
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

Preclinical studies on the role of erythropoietin (EPO) in bone metabolism are contradictory. Regeneration models indicate an anabolic effect on bone healing, whereas models on physiologic bone remodeling indicate a catabolic effect on bone mass. No human studies on EPO and fracture risk are available. It is known that fibroblast growth factor 23 (FGF23) affects bone mineralization and that serum concentration of FGF23 is higher in men with decreased estimated glomerular filtration rate (eGFR). Recently, a direct association between EPO and FGF23 has been shown. We have explored the potential association between EPO and bone mineral density (BMD), fracture risk, and FGF23 in humans. Plasma levels of EPO were analyzed in 999 men (aged 69 to 81 years), participating in the Gothenburg part of the population-based Osteoporotic Fractures in Men (MrOS) study, MrOS Sweden. The mean ± SD EPO was 11.5 ± 9.0 IU/L. Results were stratified by eGFR 60 mL/min. For men with eGFR ≥60 mL/min (n = 728), EPO was associated with age (r = 0.13, p < 0.001), total hip BMD (r = 0.14, p < 0.001), intact (i)FGF23 (r = 0.11, p = 0.004), and osteocalcin (r = -0.09, p = 0.022). The association between total hip BMD and EPO was independent of age, body mass index (BMI), iFGF23, and hemoglobin (beta = 0.019, p < 0.001). During the 10-year follow-up, 164 men had an X-ray-verified fracture, including 117 major osteoporotic fractures (MOF), 39 hip fractures, and 64 vertebral fractures. High EPO was associated with higher risk for incident fractures (hazard ratio [HR] = 1.43 per tertile EPO, 95% confidence interval [CI] 1.35-1.63), MOF (HR = 1.40 per tertile EPO, 95% CI 1.08-1.82), and vertebral fractures (HR = 1.42 per tertile EPO, 95% CI 1.00-2.01) in a fully adjusted Cox regression model. In men with eGFR<60 mL/min, no association was found between EPO and BMD or fracture risk. We here demonstrate that high levels of EPO are associated with increased fracture risk and increased BMD in elderly men with normal renal function. © 2019 American Society for Bone and Mineral Research. © 2019 American Society for Bone and Mineral Research.

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