Natalia Campos-Obando1, Martha C Castano-Betancourt, Ling Oei, Oscar H Franco, Bruno H Ch Stricker, Guy G Brusselle, Lies Lahousse, Albert Hofman, Henning Tiemeier, Fernando Rivadeneira, André G Uitterlinden, M Carola Zillikens. 1. Departments of Internal Medicine (N.C.-O., M.C.C.-B., L.O., B.H.C.S., H.T., F.R., A.G.U., M.C.Z.) and Epidemiology (M.C.C.-B., O.H.F., B.H.C.S., G.G.B., L.L., A.H., F.R., A.G.U., M.C.Z.), Erasmus MC, 3000 CA Rotterdam, The Netherlands; Department of Respiratory Medicine (G.G.B., L.L.), Ghent University Hospital, B-9000 Ghent, Belgium; Departments of Respiratory Medicine (G.G.B.) and Psychiatric Epidemiology (H.T.), Erasmus MC, 3000 CA Rotterdam, The Netherlands; and Netherlands Genomics Initiative-Sponsored Netherlands Consortium for Healthy Ageing (M.C.C.-B., L.O., O.H.F., A.H., F.R., A.G.U., M.C.Z.), 2300 RC Leiden, The Netherlands.
Abstract
CONTEXT: Low bone mineral density (BMD) has been associated with increased all-cause mortality. Cause-specific mortality studies have been controversial. OBJECTIVE: The aim of the study was to investigate associations between BMD and all-cause mortality and in-depth cause-specific mortality. DESIGN AND SETTING: We studied two cohorts from the prospective Rotterdam Study (RS), initiated in 1990 (RS-I) and 2000 (RS-II) with average follow-up of 17.1 (RS-I) and 10.2 (RS-II) years until January 2011. Baseline femoral neck BMD was analyzed in SD values. Deaths were classified according to International Classification of Diseases into seven groups: cardiovascular diseases, cancer, infections, external, dementia, chronic lung diseases, and other causes. Gender-stratified Cox and competing-risks models were adjusted for age, body mass index, and smoking. PARTICIPANTS: The study included 5779 subjects from RS-I and 2055 from RS-II. MAIN OUTCOME MEASUREMENTS: We measured all-cause and cause-specific mortality. RESULTS: A significant inverse association between BMD and all-cause mortality was found in males [expressed as hazard ratio (95% confidence interval)]: RS-I, 1.07 (1.01-1.13), P = .020; RS-II, 1.31 (1.12-1.55), P = .001); but it was not found in females: RS-I, 1.05 (0.99-1.11), P = .098; RS-II, 0.91 (0.74-1.12), P = .362. An inverse association with chronic lung disease mortality was found in males [RS-I, 1.75 (1.34-2.29), P < .001; RS-II, 2.15 (1.05-4.42), P = .037] and in RS-I in females [1.72 (1.16-2.57); P = .008], persisting after multiple adjustments and excluding prevalent chronic obstructive pulmonary disease. A positive association between BMD and cancer mortality was detected in females in RS-I [0.89 (0.80-0.99); P = .043]. No association was found with cardiovascular mortality. CONCLUSIONS: BMD is inversely associated with mortality. The strong association of BMD with chronic lung disease mortality is a novel finding that needs further analysis to clarify underlying mechanisms.
CONTEXT: Low bone mineral density (BMD) has been associated with increased all-cause mortality. Cause-specific mortality studies have been controversial. OBJECTIVE: The aim of the study was to investigate associations between BMD and all-cause mortality and in-depth cause-specific mortality. DESIGN AND SETTING: We studied two cohorts from the prospective Rotterdam Study (RS), initiated in 1990 (RS-I) and 2000 (RS-II) with average follow-up of 17.1 (RS-I) and 10.2 (RS-II) years until January 2011. Baseline femoral neck BMD was analyzed in SD values. Deaths were classified according to International Classification of Diseases into seven groups: cardiovascular diseases, cancer, infections, external, dementia, chronic lung diseases, and other causes. Gender-stratified Cox and competing-risks models were adjusted for age, body mass index, and smoking. PARTICIPANTS: The study included 5779 subjects from RS-I and 2055 from RS-II. MAIN OUTCOME MEASUREMENTS: We measured all-cause and cause-specific mortality. RESULTS: A significant inverse association between BMD and all-cause mortality was found in males [expressed as hazard ratio (95% confidence interval)]: RS-I, 1.07 (1.01-1.13), P = .020; RS-II, 1.31 (1.12-1.55), P = .001); but it was not found in females: RS-I, 1.05 (0.99-1.11), P = .098; RS-II, 0.91 (0.74-1.12), P = .362. An inverse association with chronic lung disease mortality was found in males [RS-I, 1.75 (1.34-2.29), P < .001; RS-II, 2.15 (1.05-4.42), P = .037] and in RS-I in females [1.72 (1.16-2.57); P = .008], persisting after multiple adjustments and excluding prevalent chronic obstructive pulmonary disease. A positive association between BMD and cancer mortality was detected in females in RS-I [0.89 (0.80-0.99); P = .043]. No association was found with cardiovascular mortality. CONCLUSIONS:BMD is inversely associated with mortality. The strong association of BMD with chronic lung disease mortality is a novel finding that needs further analysis to clarify underlying mechanisms.
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Authors: Natalia Campos-Obando; Lies Lahousse; Guy Brusselle; Bruno H Stricker; Albert Hofman; Oscar H Franco; André G Uitterlinden; M Carola Zillikens Journal: Eur J Epidemiol Date: 2018-05-15 Impact factor: 8.082