Anaemia Is Associated with an Increased Risk of Fractures, a Systematic Review, and Meta-Analysis

Edina Tari; Nóra Vörhendi; Szabolcs Kiss; Brigitta Teutsch; Alex Váradi; Krisztián Sisák; Hussain Alizadeh; Péter Hegyi; Bálint Erőss

doi:10.1159/000522591

Anaemia Is Associated with an Increased Risk of Fractures, a Systematic Review, and Meta-Analysis

Gerontology. 2023;69(1):1-13. doi: 10.1159/000522591. Epub 2022 Mar 21.

Authors

Edina Tari¹, Nóra Vörhendi¹, Szabolcs Kiss², Brigitta Teutsch¹, Alex Váradi¹, Krisztián Sisák³, Hussain Alizadeh⁴, Péter Hegyi^{1

5}, Bálint Erőss^{1

5}

Affiliations

¹ Institute for Translational Medicine, University of Pécs Medical School, Pécs, Hungary.
² Doctoral School of Clinical Medicine, University of Szeged, Szeged, Hungary.
³ Department of Orthopaedics, University of Szeged, Szeged, Hungary.
⁴ Division of Hematology, First Department of Medicine, University of Pécs Medical School, Pécs, Hungary.
⁵ Centre for Translational Medicine, Semmelweis University, Budapest, Hungary.

Abstract

Background: Anaemia and osteoporotic fractures are both major health problems among older adults worldwide.

Objectives: Previous studies suggest that anaemia may be associated with elevated fracture risk among older adults; however, the exact relationship between them is unknown. We aimed to investigate the association between anaemia and fracture risk.

Methods: A comprehensive literature search was performed in four medical databases. We included articles that were published from inception to February 18, 2021. Odds ratios (ORs), hazard ratios (HRs) with 95% confidence intervals (CIs), and original raw incidences from studies comparing fracture rates in anaemic versus non-anaemic patients were extracted and pooled with the random-effects model. I2 test was used to assess heterogeneity. Risk of bias assessment was performed using the Quality of Prognostic Studies tool.

Prospero: CRD42021241109.

Results: A total of 13 studies were identified; 8 of them were included in the quantitative synthesis. Anaemia was found to be a risk factor for fracture compared to non-anaemia. Anaemia increased hip fracture risk in both older men (HR = 1.71; CI: 1.46-2.00, p< 0.001, I2 = 83.2%) and women (HR = 1.31; CI: 1.13-1.52, p< 0.001), but the fracture risk was more increased among men. There was also an increased chance of hip fracture in the presence of anaemia in populations, including both older men and women (OR = 1.64; CI: 1.35-2.01, p< 0.001, I2 = 61.1%). Anaemia was also associated with increased vertebral (HR = 1.21; CI: 1.04-1.40, p = 0.012) and all-type (HR = 1.49; CI: 1.19-1.86, p< 0.001) fracture risk in older men.

Conclusion: Our results suggest that there is a significant relationship between anaemia and fracture risk in older adults. This association is stronger among older men than women and differs in the different types of fractures.

Keywords: Anaemia; Bone; Fracture risk; Older adults.

Publication types

Systematic Review
Meta-Analysis
Research Support, Non-U.S. Gov't

MeSH terms

Aged
Female
Hip Fractures*
Humans
Incidence
Male
Osteoporotic Fractures* / epidemiology
Osteoporotic Fractures* / etiology
Risk Factors

Grants and funding

The project has been supported by the European Union, co-financed by the European Social Fund, Grant No.: EFOP-3.6.1-16-2016-00004, English name: Comprehensive Development for Implementing Smart Specialization Strategies at the University of Pécs and by the Economic Development and Innovation Operational Programme Grant (GINOP-2.3.2-15-2016-00048–STAY ALIVE and GINOP-2.3.4-15-2020-00010 Competence Center for Health Data Analysis, Data Utilisation and Smart Device and Technology Development at the University of Pécs), the Human Resources Development Operational Programme Grant (EFOP 3.6.2-16-2017-00006–LIVE LONGER), the Medical School of University of Pécs.