Association of Hypoalbuminemia With Osteoporosis: Analysis of the National Health and Nutrition Examination Survey

Context: The association of hypoalbuminemia with osteoporosis in human studies is controversial. Objective: We tested the independent association between hypoalbuminemia and osteoporosis in a national dataset. Design: This is a cross-sectional observation. Setting and Participants: Participants are individuals selected from the National Health and Nutrition Examination Survey (NHANES) with available clinical, laboratory, and densitometry data from the 2005-2010 and 2013-2014 cycles. Exposure: Exposure is hypoalbuminemia defined as serum albumin <3.5 g/dL. Main Outcome Measure: Osteoporosis is defined as bone mineral density of <= 2.5 SD below the mean peak bone mass of young, healthy adults. Analysis took into account the hidden variance and the weighting methodology pertinent to analysis of NHANES. Results: Overall, 15 539 individuals were included. The mean age was 48.6 years (SE = 0.27). Fifty percent of the individuals were male, and 10.2% were of the black race. There was a graded decrease in the rate of osteoporosis from 15.2% at albumin <.5 g/dL to 2.6% at albumin >4 g/dL (P = .007) at the femoral neck and from 11.0 to 1.4% at total femur (P = .009). In a fully adjusted model, the odds of osteoporosis with hypoalbuminemia were 5.37-fold (95% confidence interval [CI], 1.43 to 20.20; P = .014) at the femoral neck, 12.46-fold (95% CI, 3.24 to 48.01; P < .001) at total femur, and 4.59-fold (95% CI, 1.49 to 14.16; P = .025) at the lumbar spine higher as compared to albumin >4 mg/dL. Conclusion: In the NHANES dataset, we report an independent association of osteoporosis with hypoalbuminemia at different anatomical sites.