JBMR Plus · Oct 9, 2026

Albuminuria, glomerular filtration rate, and fracture among U.S. adults with and without type 2 diabetes

By Hsu S, Zelnick LR, de Boer IH et al.

CKD and type 2 diabetes (T2D) are established risk factors for fracture. Albuminuria and reduced estimated glomerular filtration rate (eGFR), the most commonly used measures to diagnose CKD, may confer fracture risk through distinct mechanisms. Clarifying the associations of albuminuria, reduced eGFR, and T2D status with fracture risk and potential interactions between these exposures may improve fracture risk assessment. We performed a cross-sectional study of 20 034 participants 50 yr or older in the National Health and Nutrition Examination Survey (NHANES) from 1999 to 2020. Albuminuria was defined by spot urine albumin-to-creatinine ratio ≥30 mg/g; reduced eGFR was defined as <60 mL/min/1.73 m². Outcomes were prevalent hip and any fracture-the composite of any hip, wrist, or spine fracture-ascertained using self-report of physician diagnosis. Mean age was 63 yr; 53% were female, 9% were non-Hispanic Black, and 5% were Mexican-American. Participants reported 417 hip and 2703 any fractures. After adjusting for demographic and clinical covariates, including osteoporosis diagnosis and treatment, albuminuria was associated with increased odds of hip fracture (OR 1.59, 95% CI: 1.13-2.22), with no significant interaction by eGFR or T2D status. Neither reduced eGFR (OR 1.02; 95% CI: 0.73-1.44) nor T2D status (OR 0.94; 95% CI: 0.63-1.39) was associated with higher odds of hip fracture. Albuminuria, reduced eGFR, and T2D were not significantly associated with any fracture. In a subset of 7005 participants with BMD measurements, additional adjustment for FN BMD partially attenuated the association of albuminuria with hip fracture (OR 1.35; 95% CI: 0.72-2.53). In conclusion, albuminuria is associated with hip fracture in adults with and without T2D, independent of eGFR.

doi.org/10.1093/jbmrpl/ziag166 Open access PubMed 42928907 Populations