Calcified Tissue International

, Volume 104, Issue 1, pp 26–33 | Cite as

Elevated Red Blood Cell Distribution Width Is Associated with Morphometric Vertebral Fracture in Community-Dwelling Older Adults, Independent of Anemia, Inflammation, and Nutritional Status: The Korean Urban Rural Elderly (KURE) Study

  • Namki Hong
  • Chang Oh Kim
  • Yoosik Youm
  • Jin-Young Choi
  • Hyeon Chang Kim
  • Yumie RheeEmail author
Original Research


Elevated red blood cell distribution width (RDW), a simple measure of red blood cell size heterogeneity, has been associated with increased mortality and morbidity in the elderly population, which might reflect systemic inflammation and malnutrition. However, whether elevated RDW is associated with prevalent morphometric vertebral fracture (VF) in older adults has not been investigated. We examined 2127 individuals (mean age 71.7 years; women 66%) from a community-based cohort. VF was defined as ≥ 25% reduction in vertebral column height using the Genant semiquantitative method. Multiple VF was defined as the presence of VF at two or more sites. The prevalence of any VF and multiple VF was 14% and 4%, respectively, increasing from the lowest to the highest RDW tertiles (12–18% and 3–6%, p for trend < 0.05 for all). RDW was positively associated with age, body mass index (BMI), malnutrition, and high-sensitivity C-reactive protein (hsCRP), whereas it was negatively associated with albumin, hemoglobin, and ferritin levels. Elevated RDW was associated with any VF [adjusted odds ratio (aOR) 1.26; p = 0.008] and multiple VF (aOR 1.36; p = 0.010) after adjustment for covariates, including age, sex, BMI, hsCRP, malnutrition, self-reported previous fracture, falls, osteoporosis, and hemoglobin and ferritin levels. The association between elevated RDW and VF remained robust in subgroups with (aOR 1.39; p = 0.048) or without anemia (aOR 1.26; p = 0.030). Elevated RDW was associated with prevalent morphometric VF in community-dwelling elderly individuals, independent of anemia, inflammation, and nutritional status.


RDW Bone Aging Vertebral fracture Erythropoiesis 



We thank all our participants and the technical staff of the KURE study.

Author Contributions

NH and YR designed the study and prepared the first draft of the paper. YR is guarantor. All authors participated in the KURE cohort study as steering committee members. COK, YY, and HCK were responsible for the integrity of data. NH was responsible for the statistical analysis of the data. J-YC reviewed and confirmed the interpretation of imaging dataset. All authors revised the paper critically for intellectual content and approved the final version. All authors agree to be accountable for the work and to ensure that any questions relating to the accuracy and integrity of the paper are investigated and properly resolved.


This work was supported by the Research of Korea Centers for Disease Control and Prevention (Grant Numbers 2013-E63007-01, 2013-E63007-02).

Compliance with Ethical Standards

Conflict of interest

Namki Hong, Chang Oh Kim, Yoosik Youm, Jin-Young Choi, Hyeon Chang Kim, and Yumie Rhee declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

The study was approved by the Institutional Review Board (IRB) of Severance Hospital (IRB No. 4-2012-0172), with written informed consent obtained from all participants. All procedures performed in studies involving human participants were in accordance with the ethical standards of the IRB and with the 1964 Helsinki Declaration and its later amendments.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Internal Medicine, Severance Hospital, Endocrine Research InstituteYonsei University College of MedicineSeoulSouth Korea
  2. 2.Graduate SchoolYonsei University College of MedicineSeoulSouth Korea
  3. 3.Division of Geriatrics, Department of Internal Medicine, Severance HospitalYonsei University College of MedicineSeoulSouth Korea
  4. 4.Department of SociologyYonsei University College of Social SciencesSeoulSouth Korea
  5. 5.Department of Radiology, Research Institute of Radiological Science, Severance HospitalYonsei University College of MedicineSeoulSouth Korea
  6. 6.Department of Preventive MedicineYonsei University College of MedicineSeoulSouth Korea

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