Association of bone mineral density with hemoglobin and change in hemoglobin among older men and women: The Cardiovascular Health Study

Abstract Purpose Osteoblasts and their precursors support hematopoiesis in the bone marrow. We hypothesized that declines in Hgb levels are associated with bone mineral density (BMD). Methods The Cardiovascular Health Study is a prospective longitudinal study that enrolled 5888 community-dwelling adults aged >65 years and measured hemoglobin twice, in 1989–90 and 1992–93, as well as BMD by dual-energy X-ray absorptiometry (DXA) in 1994–95. In a subset of 1513 men and women with a Hgb in 1992–93 and BMD, we used linear regression to estimate associations of Hgb (per standard deviation (SD)) with total hip (TH), lumbar spine (LS) and total body (TB) BMD, and used Poisson regression to estimate associations of anemia (in 1992–93; Hgb Results No significant association was observed between Hgb, measured a mean 2.2 years prior to BMD, and BMD at the TH and LS in men (TH beta = −0.60 [x 10 −2  g/cm 2 per 1.1 g/dL Hgb], 95% CI: -1.88 to 0.68; LS beta = −1.69, 95% CI: -3.83 to 0.45) or women (TH beta = −0.49 [x 10 −2  g/cm 2 per 1.3 g/dL Hgb], 95% CI: -1.57 to 0.59; LS beta = −0.40, 95% CI: -2.57 to 1.76). Anemia was not observed to be significantly associated with low BMD in men (RR = 0.99, 95% CI: 0.72–1.40) nor women (RR = 0.98, 95% CI: 0.82–1.17). The mean change in Hgb was a loss of 0.06 g/dL/year (SD = 0.32). Change in Hgb was not observed to be significantly associated with BMD in men (TH beta = −0.55[x 10 −2  g/cm 2 per 1 g/dL annualized Hgb change], 95% CI: -4.28 to 3.19; LS beta = 0.63, 95% CI: -5.38 to 6.65) or women (TH beta = 0.92, 95% CI: -1.96 to 3.79; LS beta = −1.77, 95% CI: -7.52 to 3.98). No significant association was observed between anemia and low bone density by T-score in men and women. Conclusions These findings support neither the hypothesis that low Hgb prior to bone density or decreases in Hgb are associated with bone density in older community-dwelling adults nor the use of Hgb level as a case-finding tool to prompt BMD measurement.