• Yanjun Huang, Cheng Huang, Yanzhu Shen, Qidong Zhang, Jinzhu Dai, Wenjing Xiong, Xiangsheng Tang, Ping Yi, and Jun Lin.
• Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100006, China.
• Postgrad Med J. 2024 Jul 24.

PurposeOsteoporosis (OP) is characterized by a gradual onset and an increased susceptibility to osteoporotic fractures. Previous retrospective studies have suggested that hemoglobin (HGB) levels could be a potential diagnostic marker for OP. However, the relationship between OP and anemia remains uncertain. This prospective study aimed to investigate the association between HGB levels and OP.MethodsLeveraging data from the UK Biobank, a cohort of 452 778 individuals was analyzed. Employing a modified Cox proportional hazards model that accounted for sociodemographic factors, lifestyle, and health-related factors, we examined the links between incident OP and sex. Moreover, we investigated the impact of OP with or without a pathological fracture.ResultsFollowing a median follow-up period of 5.85 years, 4294 participants were diagnosed with OP. After adjusting for a comprehensive range of pertinent confounders, individuals with anemia exhibited a 2.15-fold higher risk of OP in males and a 1.41-fold higher risk in females. Moreover, each unit increase in HGB concentration corresponded to a 0.83-fold decrease in OP risk for men and a 0.94-fold decrease for women.PerspectivesOur findings reveal a significant correlation between HGB levels or anemia and OP, with males demonstrating a greater susceptibility compared to females. The risk of OP decreased with higher HGB concentrations in both sexes, although this effect was more pronounced in males. It is recommended to conduct longitudinal studies to investigate the causality of the observed connections and experimental studies to understand the underlying mechanisms.© The Author(s) 2024. Published by Oxford University Press on behalf of Fellowship of Postgraduate Medicine.

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