Relationship between Moderate to Severe Kidney Disease and Hip Fracture in the United States

Abstract

People with ESRD are at a high risk for hip fracture. However, the effect of moderate to severe chronic kidney disease (CKD) on hip fracture risk has not been well studied. As part of the Third National Health and Nutrition Examination Survey, information on both kidney function and history of hip fracture was obtained. This survey is a complex, multistage, probability sample of the US noninstitutionalized civilian population and was conducted between 1988 and 1994. A history of hip fracture was identified from the response to a questionnaire that was administered to all participants. There were 159 cases of hip fracture. There was a significantly increased likelihood of reporting a hip fracture in participants with estimated GFR <60 ml/min (odds ratio [OR] 2.12; 95% confidence interval [CI] 1.18 to 3.80). In younger participants (aged 50 to 74 yr), the prevalence of CKD was approximately three-fold higher in those with a history of hip fracture versus in those without a history of hip fracture (19.0 versus 6.2%, respectively; P ‫؍‬ 0.04). In multivariate logistic regression analysis, only the presence of CKD (OR 2.32; 95% CI 1.13 to 4.74), a reported history of osteoporosis (OR 2.52; 95% CI 1.08 to 5.91), and low physical activity levels (OR 2.10; 95% CI 1.03 to 4.27) were associated with a history of hip fracture. There is a significant association between hip fracture and moderate to severe degrees of CKD, particularly in younger individuals, that is independent of traditional risk factors for hip fracture.

Fracture Burden and Risk Factors in Childhood CKD

“…Numerous studies have demonstrated increased fracture rates in adults with ESRD [8][9][10][11][12][13][14][15][16][17] and CKD. [20][21][22][23][24][25][26][27][28][29][30][31] With 90% of peak skeletal mass accrued by age 18, children with CKD are uniquely vulnerable to its multiple threats to bone health, but the The total n exceeds 67 first fracture events as there were fractures involving multiple sites.…”

“…19 Several studies have extended these observations to adults with moderate CKD. [20][21][22][23][24][25][26][27][28][29][30][31] Until recently, studies in children were limited to a report in solid organ transplant recipients, demonstrating a 6-fold higher incidence of all fractures and 160-fold higher incidence of vertebral fractures. 32 We subsequently completed a study in 170 children and adolescents with CKD and ESRD.…”

Differences in Bone Quality in Low- and High-Turnover Renal Osteodystrophy

“…Abnormal bone turnover occurs in approximately 85% of patients with CKD stage 5 on dialysis (CKD-5D), 2 and within this patient group, there is a greater risk of bone fracture than within the general population. [3][4][5] Although turnover abnormalities are well described, 1 little information is available on whether these abnormalities are associated with changes in bone quality. Bone quality is the contemporary term used to refer to the structural and material parameters that collectively enable bone to bear load and resist fracture or excessive deformation.…”

Discriminants of Prevalent Fractures in Chronic Kidney Disease

“…[1][2][3] Cross-sectional data suggest fracture risk increases as kidney function declines and by CKD stage 4 approximates that for ESRD. 2 Furthermore, fracture-related mortality for patients with predialysis CKD is approximately twofold higher than the general population.…”