Increased risk of mortality associated with hip fracture in the dialysis population

Mittalhenkle, Anuja; Gillen, Daniel L.; Stehman‐Breen, Catherine

doi:10.1016/s0272-6386(04)00958-8

Cited by 157 publications

(96 citation statements)

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“…Mittalhenkle et al [46] firstly focused on hip fracture and found that hip fracture was significantly correlated with high all-cause mortality in dialysis patients. In this study, we found that the CV events and all-cause death in the FF group were all higher than those in the control group.…”

Section: Discussionmentioning

confidence: 99%

Factors and Outcome of Renal Osteodystrophy-Associated Initial Fragility Fracture in End-Stage Renal Disease Patients

et al. 2019

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Background: Renal osteodystrophy has caused increased risk of fragility fracture in end-stage renal disease (ESRD) patients. However, risk factors and outcome of ESRD patients with fragility fracture remain uncharacterized. We aimed to assess these parameters in ESRD patients. Summary: This retrospective case-control study analyzed 354 ESRD patients (initial fragility fracture [FF] group, n = 59; control group, n = 295). Pre-dialysis blood hemoglobin, serum albumin, lipid, calcium, phosphorus, alkaline phosphatase (ALP), and intact parathyroid hormone (iPTH) were collected. All procedures performed involving human participants were in accordance with the ethical standards of the institutional committee of The First Affiliated Hospital of Chongqing Medical University (IRB approval number 216-82), and informed consent was obtained from all participants. There were higher prevalence rates of primary hypertension and diabetes, higher serum ALP, corrected calcium, and lower serum total cholesterol, low-density lipoprotein, lipoprotein-α, and iPTH in the FF group. Fractures were more likely to occur in the higher level of corrected calcium as well as in the lower iPTH group. High corrected calcium (p = 0.010, OR = 11.308, 95% CI: 1.770–72.242) and serum ALP (p = 0.000, OR = 1.007, 95% CI: 1.004–1.011) were independent risk factors of fragility fracture. The incidence of all-cause mortality and cardiovascular (CV) events in ESRD patients with fragility fracture was higher than in those without fracture. Key Messages: Patients with hypertension, diabetes, excessive suppression of PTH, and poor nutritional status are more prone to fractures. Serum corrected calcium and ALP were independent risk factors of fragility fracture. Patients with initial fragility fracture had more CV events and higher mortality.

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Section: Discussionmentioning

confidence: 99%

Factors and Outcome of Renal Osteodystrophy-Associated Initial Fragility Fracture in End-Stage Renal Disease Patients

et al. 2019

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“…Similarly, hip fracture was associated with a twofold increase in the incident rate ratio for all-cause mortality in dialysis patients. Mortality secondary to cardiovascular disease, infection, metabolic causes and malnutrition were 2-to 3-fold higher in patients with hip fracture compared to the non-fracture group [4]. In a retrospective analysis of 1,272 patients on hemodialysis, the incidence of hip fracture was 13.9 per 1,000 patient-years [3].…”

Section: Bmd and Fracture Risk In Renal Failurementioning

confidence: 94%

“…The incidence of fractures is much higher in these patients compared to the general population [1][2][3]. Furthermore, mortality associated with hip fractures is higher in these patients compared to the general population [4]. In addition, there is an increasing amount of evidence suggesting a potential link between bone and mineral metabolism and cardiovascular disease [5,6], therefore the term CKD-mineral and bone disorder (CKD-MBD) has been suggested to describe the complexity of the syndrome [7].…”

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confidence: 99%

Bone mineral density in patients on maintenance dialysis

et al. 2009

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Disorders of bone and mineral metabolism affect almost all patients with advanced chronic kidney disease (CKD). High prevalence of decreased bone mineral density has been reported in this population; however, the role and diagnostic utility of bone density measurements are not well established. The incidence of bone fractures is high in patients with ESRD, but the association between fractures and bone density is not obvious. A recent meta-analysis suggested that decreased density at the radius might be associated with higher overall fracture risk. Changes in bone mineral density reflect several underlying pathological processes, such as vitamin D deficiency, estrogen deficiency and changes in bone turnover. The response of bone to these factors and processes is not uniform: it can vary in different compartments of the same bone or in different bones of the skeleton. Therefore, it is important to differentiate between the various types of bone. This may be possible by proper selection of the measurement site or using methods such as quantitative bone computed tomography. Previous studies used different methods and measured bone mineral density at diverse sites of the skeleton, which makes the comparison of their results very difficult. The association between changes in bone mineral metabolism and cardiovascular mortality is well known in ESRD patients. Studies also suggest that low bone density itself might be an indicator for high risk of cardiovascular events and poor overall outcome in this population. Some of the risk factors of low bone mineral density, such as vitamin D or estrogen deficiency, are potentially modifiable. Further studies are needed to elucidate if interventions modifying these risk factors will have an impact on clinical outcomes. In this review, we discuss the options for and problems of assessment of bone density and summarize the literature about factors associated with low bone density and its link to clinical outcomes in patients on maintenance dialysis.

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“…Besides, several medical and nonmedical factors have been associated with the mortality rate from hip fractures. Compared with the general population, patients with end-stage renal disease have significantly higher mortality rates after hip fracture [9]. Poor hygiene in assisted care and hospital settings can also increase mortality rates after a hip fracture [10,11].…”

Section: Introductionmentioning

confidence: 99%

Rheumatoid arthritis patients with hip fracture: a nationwide study

Lin

Chang

et al. 2014

Osteoporos Int

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Compared to patients without RA, those with RA have a higher incidence of hip fractures at a relatively younger age and with higher complication and mortality rates. Steroid and disease-modifying anti-rheumatic drugs, the most common medicine in Taiwanese RA patients, might contribute to the high incidence of fracture and post-op infection. Appropriate early intervention to prevent hip fractures in RA patients is a critical issue in rheumatology care.

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Increased risk of mortality associated with hip fracture in the dialysis population

Abstract: Hip fracture is associated with an increased risk of all-cause mortality in the dialysis population.

Cited by 157 publications

References 0 publications

Factors and Outcome of Renal Osteodystrophy-Associated Initial Fragility Fracture in End-Stage Renal Disease Patients

Factors and Outcome of Renal Osteodystrophy-Associated Initial Fragility Fracture in End-Stage Renal Disease Patients

Bone mineral density in patients on maintenance dialysis

Rheumatoid arthritis patients with hip fracture: a nationwide study

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