• Setor K Kunutsor, Ari Voutilainen, Michael R Whitehouse, Samuel Seidu, Jussi Kauhanen, Ashley W Blom, and Jari A Laukkanen.
• National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol, Bristol, United Kingdom, skk31@cantab.net.
• Med Princ Pract. 2019 Jan 1; 28 (5): 401409401-409.

ObjectiveLow serum albumin concentration is associated with poor health outcomes, but its relationship with the risk of fractures has not been reliably quantified. We aimed to assess the prospective association of serum albumin with the risk of fractures in a general population.Subjects And MethodsBaseline serum albumin concentrations were measured in 2,245 men aged 42-61 years in the Kuopio Is-chemic Heart Disease study. Hazard ratios (HRs) (95% confidence intervals) were calculated for incident fractures.ResultsA total of 121 fractures (hip, humeral, or wrist) were recorded during a median follow-up of 25.6 years. The risk of fractures increased linearly below a serum albumin concentration of ∼48 g/L. The age-adjusted HR (95% CI) for fractures per 1 standard deviation lower serum albumin was 1.24 (1.05-1.48). On further adjustment for several conventional and emerging risk factors, the HR was attenuated to 1.21 (1.01-1.45). Comparing the bottom versus top quartile of serum albumin levels, the corresponding adjusted HRs were 2.48 (1.37-4.48) and 2.26 (1.23-4.14). The association of serum albumin with fracture risk did not differ substantially according to age, body mass index, blood pressure, physical activity, alcohol consumption, socioeconomic status, inflammation, prevalent diseases, and smoking. Serum albumin at a threshold of 41.5 g/L demonstrated an area under the curve of 0.5850.ConclusionIn middle-aged Caucasian men, low serum albumin is associated with an increased risk of future fractures. The potential relevance of serum albumin concentrations in fracture prevention and prediction deserves further evaluation.© 2019 The Author(s) Published by S. Karger AG, Basel.

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