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Association of white matter hyperintensities with BMD, incident fractures, and falls in the UK Biobank cohort

队列 骨质疏松症 医学 髋部骨折 危险系数 比例危险模型 队列研究 人口 股骨 骨矿物 内科学 外科 置信区间 环境卫生
作者
Lishan Cai,Xingyu Lv,Xiang Li,Xuan Wang,Hao Ma,Yoriko Heianza,Lu Qi,Tao Zhou
出处
期刊:Journal of Bone and Mineral Research [Oxford University Press]
卷期号:39 (4): 408-416 被引量:1
标识
DOI:10.1093/jbmr/zjae031
摘要

Abstract Osteoporosis is the most common metabolic bone disease globally, which increases the healthcare service burden. Recent studies have linked higher white matter hyperintensities (WMH) to reduced BMD, increasing the risk of fractures and falls in older adults. However, limited evidence exists regarding the dose–response relationship between WMH and bone health in a larger and younger population. Our study aimed to examine the association of WMH volume with BMD, incident fractures and falls, focusing on dose–response relationship with varying levels of WMH volume. We included 26 410 participants from the UK Biobank. The association between WMH volume and BMD was analyzed using multiple linear regression. Cox regression models were used to estimate the hazard ratios of incident fractures and falls. Restricted cubic spline (RCS) fitted for linear and Cox regression models were employed to explore potential non-linearity. Over a mean follow-up time of 3.8 yr, we documented 59 hip fractures, 392 all fractures, and 375 fall incidents. When applying RCS, L-shaped relationships were identified between WMH volume and BMD across all 4 sites. Compared with those in the lowest fifth of WMH volume, individuals in the second to the highest fifths were associated with a reduction of 0.0102–0.0305 g/cm2 in femur neck BMD, 0.0075–0.0273 g/cm2 in femur troch BMD, 0.0173–0.0345 g/cm2 in LS BMD, and 0.0141–0.0339 g/cm2 in total body BMD. The association was more pronounced among women and younger participants under age 65 (Pinteraction < .05). Per 1 SD increment of WMH volume was associated with 36.9%, 20.1%, and 14.3% higher risks of incident hip fractures, all fractures, and falls. Genetically determined WMH or apolipoprotein E genotypes did not modify these associations. We demonstrated that a greater WMH was associated with BMD in an L-shaped dose–response manner, especially in women and those under 65 yr.
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