Trial reportJournal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research2013
C-reactive protein, bone strength, and nine-year fracture risk: data from the Study of Women's Health Across the Nation (SWAN).
Trial report in Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research, 2013. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 61 papers, 2 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
61 citing papers in PubMed, 2 syntheses or guidelines pooled it, 108 citations in OpenAlex.
- C-reactive protein and fracture risk: an updated systematic review and meta-analysis of cohort studies through the use of both frequentist and Bayesian approaches.Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA · 2021Pooled it
- C-reactive protein and risk of fracture: a systematic review and dose-response meta-analysis of prospective cohort studies.Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA · 2015Pooled it
- A randomized, double-blind, placebo-controlled clinical study to evaluate the efficacy of the synbiotic medical food, SBD111, for the clinical dietary management of bone loss in menopausal women.Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA · 2025Trial
- Dietary Inflammatory Potential and Bone Outcomes in Midwestern Post-Menopausal Women.Nutrients · 2023Trial
- The Short-Term Effect of Prunes in Improving Bone in Men.Nutrients · 2022Trial
- Pleiotropic effects of obesity on fracture risk: the Study of Women's Health Across the Nation.Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research · 2014Trial
- High-sensitivity CRP is an independent risk factor for all fractures and vertebral fractures in elderly men: the MrOS Sweden study.Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research · 2014Trial
- Markers of compromised gut epithelial barrier integrity increase during the menopause transition.The Journal of clinical investigation · 2026Article
- Association Between Chronic Inflammation, Bone Density, and Muscle in Peripubertal Adolescents With and Without HIV in Zimbabwe: A Cross-sectional Study.Open forum infectious diseases · 2026Article
- The effect of hypersensitive C-reactive protein to albumin ratio on the risk of fragility fracture in the Chinese male population.Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA · 2025Article
- Osteosarcopenia in Chronic Kidney Disease: An Overlooked Syndrome?Journal of cachexia, sarcopenia and muscle · 2025Review
- The association between relative fat mass (RFM) and lumbar bone density in US adults: Insight from 2011-2018 NHANES.PloS one · 2025Article
- The study findings demonstrated a significant association between C-reactive protein levels and trabecular bone score : NHANES 2005-2008.Journal of orthopaedic surgery and research · 2024Article
- Association between composite indices of femoral neck strength and odds of hip fracture.Archives of osteoporosis · 2024Article
- Sleep-wake changes and incident depressive symptoms in midlife women.Scientific reports · 2024Article
- Prediction of subsequent fragility fractures: application of machine learning.BMC musculoskeletal disorders · 2024Article
- Obesity and Skeletal Fragility.The Journal of clinical endocrinology and metabolism · 2024Review
- Association Between the Dietary Inflammatory Index and the Risk of Fracture in Chinese Adults: Longitudinal Study.JMIR public health and surveillance · 2023Article
- Dietary Inflammatory Index and Fractures in Midlife Women: Study of Women's Health Across the Nation.The Journal of clinical endocrinology and metabolism · 2023Article
- Associations between blood inflammatory markers and bone mineral density and strength in the femoral neck: findings from the MIDUS II study.Scientific reports · 2023Article
1 more citing papers are in PubMed but not listed here.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
7 authors at 3 institutions in 3 countries.
Funding
Abstract
Higher levels of C-reactive protein (CRP), an inflammatory marker, are associated with increased fracture risk, although previous studies on CRP and bone mineral density (BMD) have yielded conflicting results. We aimed to test the hypotheses that composite indices of femoral neck strength relative to load, which are inversely associated with fracture risk, would also be inversely associated with CRP, and would explain part of the association between CRP and fracture risk. We analyzed data from a multisite, multiethnic prospective cohort of 1872 community-dwelling women, premenopausal or early perimenopausal at baseline. Femoral neck composite strength indices in three failure modes were calculated using dual-energy X-ray absorptiometry (DXA)-derived femoral neck width (FNW), femoral neck axis length (FNAL), femoral neck BMD and body size at baseline, as BMD*FNW/weight for compression strength, BMD*(FNW)(2) /(FNAL*weight) for bending strength, and BMD*FNW*FNAL/(height*weight) for impact strength. Incident nondigital, noncraniofacial fractures were ascertained annually over a median follow-up of 9 years. In analyses adjusted for age, race/ethnicity, diabetes, menopause transition stage, body mass index, smoking, alcohol use, physical activity, medications, prior fracture, and study site, CRP was associated inversely with each composite strength index (0.035-0.041 SD decrement per doubling of CRP, all p < 0.001), but not associated with femoral neck or lumbar spine BMD. During the follow-up, 194 women (10.4%) had fractures. In Cox proportional hazards analyses, fracture hazard increased linearly with loge (CRP), only for CRP levels ≥ 3 mg/L. Addition of femoral neck or lumbar spine BMD to the model did not attenuate the CRP-fracture association. However, addition of any of the composite strength indices attenuated the CRP-fracture association and made it statistically nonsignificant. We conclude that fracture risk increases with increasing CRP, only above the threshold of 3 mg/L. Unlike BMD, composite strength indices are inversely related to CRP levels, and partially explain the increased fracture risk associated with inflammation.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.