The Analysis for Anemia Increasing Fracture Risk

Abstract

BACKGROUND Fractures are a major public health problem for elderly people throughout the world. Anemia is also a common, important health problem among elderly populations. The aim of this article was to estimate the association between anemia and fracture incidence via a systematic review and meta-analysis. MATERIAL AND METHODS The participant, intervention, observation, and study design (PICOS) reporting guidelines were followed, and databases were searched from their inception to May 2020 to identify relevant studies. When heterogeneity was significant, and a random-effects model was used. Subgroup analysis was conducted to explore the source of heterogeneity based on sex, study design, and region. RESULTS We found that anemia significantly increased fracture risk [relative risk (RR)=1.26, 95% confidence interval (CI)=1.14-1.39, P<0.001], specifically, hip fracture (RR=1.44, 95% CI=1.29-1.61), spine fracture (RR=1.15, 95% CI=1.08-1.23), and nonspine fracture (RR=1.42, 95% CI=1.33-1.52). Males with anemia had a 1.51-fold higher fracture risk, females had a 1.09-fold higher fracture risk. And the association was stronger in Asian (RR=1.22, 95% CI=1.07-1.40), but not in American and European study populations. CONCLUSIONS In conclusion, a significantly increased fracture risk was observed, and anemia can be a predictor of fracture risk.

Figure 1

Flow chart of the meta-analysis.

Figure 2

Forest plot. (A). Forest plot of the of anemia association with fracture risk. (B) Forest plot of anemia association with hip fracture risk. (C) Forest plot of anemia association with spine fracture risk. (D) Forest plot of anemia association with nonspine fracture risk. (CI – confidence interval).

Figure 3

Sensitivity analysis. The analysis was performed via recalculation of the pooled results of the primary analysis after exclusion of one study per iteration.