“Anemia can weaken bones, too” ... Fracture risk rises regardless of bone density [Health Check]

[Financial News] It is too early to feel reassured, even if a bone-density test result is normal. If a routine health-screening blood test shows anemia or an abnormal red blood cell count, fracture risk may be elevated.
A joint research team comprising Professor Ha Jeong-hun of the Department of Endocrinology at Seoul St. Mary’s Hospital, Catholic University of Korea, and Professor Joy Y. Wu of Stanford University School of Medicine in the United States followed 418,959 UK Biobank participants for a median of 13.2 years. The team found that fracture risk was higher regardless of bone density among people whose red blood cell distribution width (RDW) and mean corpuscular volume (MCV) were elevated or who had anemia.
Osteoporotic fractures are a major condition that can devastate the quality of life of older adults. The one-year mortality rate among patients with hip fractures in South Korea reaches approximately 21% for men and 14% for women. Since most occur without warning signs, it is important to identify people at high risk before their first fracture.
People often feel reassured when their bone density is normal, but in clinical practice, quite a few patients suffer fractures from minor impacts despite having good bone density. That is because conventional bone-density tests, which measure the “quantity” of bone, cannot readily detect a decline in “bone quality.”
The research team focused on how hematopoietic cells that produce blood and bone tissue that forms bone share the same microenvironment—the bone marrow—and communicate closely. The team’s insight was that the state of the blood could serve as a signal of bone condition.
The team followed participants with no history of fractures, and a total of 16,466 fractures occurred during the follow-up period. The analysis found a significantly higher risk of fracture among people whose RDW and MCV were elevated or who were anemic. A separate analysis of 36,549 people with bone-density data also found that the association between abnormal blood markers and fracture risk could not be explained by differences in bone density alone. The large-scale data thus support the possibility that fracture risk may be elevated in people with abnormal blood markers even when their bone density is within the normal range.
The study is significant because it provides evidence that results from routine blood tests—the kind everyone receives—can be taken into account when assessing fracture risk, without expensive equipment or complex additional tests. Physiological mechanisms also support this, as anemia, chronic inflammation, and platelet abnormalities are involved in the balance between bone formation and resorption.
Professor Ha emphasized, “The significance lies in having followed a large population over an extended period, comprehensively analyzed the association between blood markers and fracture risk, and demonstrated that this risk is an independent factor that cannot be explained by bone density alone. If routine checkups show persistent anemia or abnormalities in RDW or MCV, people should take particular care of their bone health and take steps to prevent falls, even if their bone density is normal.”
Professor Ha was selected to give an oral presentation at the 2026 Annual Meeting of the American Society for Bone and Mineral Research (ASBMR) for this study, and was also named a recipient of the “Mid-Career Faculty Travel Grant,” awarded to outstanding mid-career researchers. The team had previously published a review article outlining the mechanisms behind interactions between blood markers and bone metabolism, “Complete Blood Count Parameters and Bone Health: Clinical and Experimental Evidence,” in 2025 in the Korean Endocrine Society’s international journal, Endocrinology and Metabolism (EnM).
 


[email protected] Jeong Myeong-jin, Medical Correspondent Reporter