Association of Immune Cell Subsets with Incident Hip Fracture: The Cardiovascular Health Study

Rachel E. Elam, Petra Bůžková, Joseph A.C. Delaney, Howard A. Fink, Joshua I. Barzilay, Laura D. Carbone, Rick Saha, John A. Robbins, Kenneth J. Mukamal, Rodrigo J. Valderrábano, Bruce M. Psaty, Russell P. Tracy, Nels C. Olson, Sally A. Huber, Margaret F. Doyle, Alan L. Landay, Jane A. Cauley

Research output: Contribution to journalArticlepeer-review


In this study, we aimed to evaluate the association of innate and adaptive immune cell subsets in peripheral blood mononuclear cells (PBMCs) with hip fracture. To conduct this study, we used data from the Cardiovascular Health Study (CHS), a U.S. multicenter observational cohort of community-dwelling men and women aged ≥ 65 years. Twenty-five immune cell phenotypes were measured by flow cytometry from cryopreserved PBMCs of CHS participants collected in 1998–1999. The natural killer (NK), γδ T, T helper 17 (Th17), and differentiated/senescent CD4+CD28 T cell subsets were pre-specified as primary subsets of interest. Hip fracture incidence was assessed prospectively by review of hospitalization records. Multivariable Cox hazard models evaluated associations of immune cell phenotypes with incident hip fracture in sex-stratified and combined analyses. Among 1928 persons, 259 hip fractures occurred over a median 9.7 years of follow-up. In women, NK cells were inversely associated with hip fracture [hazard ratio (HR) 0.77, 95% confidence interval (CI) 0.60–0.99 per one standard deviation higher value] and Th17 cells were positively associated with hip fracture [HR 1.18, 95% CI 1.01–1.39]. In men, γδ T cells were inversely associated with hip fracture [HR 0.60, 95% CI 0.37–0.98]. None of the measured immune cell phenotypes were significantly associated with hip fracture incidence in combined analyses. In this large prospective cohort of older adults, potentially important sex differences in the associations of immune cell phenotypes and hip fracture were identified. However, immune cell phenotypes had no association with hip fracture in analyses combining men and women.

Original languageEnglish (US)
Pages (from-to)581-590
Number of pages10
JournalCalcified Tissue International
Issue number6
StatePublished - Dec 2023
Externally publishedYes


  • Biomarkers
  • Fracture
  • Immunity
  • Inflammation
  • Osteoporosis
  • Risk factors

ASJC Scopus subject areas

  • Endocrinology, Diabetes and Metabolism
  • Orthopedics and Sports Medicine
  • Endocrinology


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