The FRAX® as a predictor of mortality in Japanese incident hemodialysis patients: an observational, follow-up study

Abstract

The World Health Organization Fracture Risk Assessment Tool (FRAX(®)) was recently developed to estimate the 10-year absolute risk of osteoporotic fracture among the general population. However, the evidence for its use in chronic kidney disease patients has been lacking, and the association between the FRAX(®) and mortality is unknown. Therefore, a hospital-based, prospective, cohort study was conducted to evaluate the predictive ability of the FRAX(®) for mortality in hemodialysis patients. A total of 252 patients who had been started on maintenance hemodialysis, 171 men and 81 women, with a mean age of 67 ± 14 years, was studied. The endpoint was defined as all-cause death. The Cox proportional hazards model was used to calculate hazard ratios and 95 % confidence intervals. During the mean follow-up period of 3.4 ± 2.7 years, 61 deaths occurred. The median (interquartile range) of the FRAX(®) for major osteoporotic fracture was 6.9 (4.6-12.0) % in men and 19.0 (7.6-33.0) % in women. Cumulative survival rates at 5 years after starting dialysis, with the FRAX(®) levels above and below the median, were 51.9 and 87.9 %, respectively, in men and 67.4 and 83.7 %, respectively, in women. Overall, in men, the multivariate Cox regression analyses revealed that the log-transformed FRAX(®) remained an independent predictor of death after adjusting by confounding variables. However, in women, the significant association between the FRAX(®) value and the outcome was eliminated if age was put into these models. Among Japanese hemodialysis patients, the FRAX(®) seems to be useful for predicting death, especially in men.

Relationship between the FRAX index and physical and cognitive functioning in older people

“…After a hip fracture, the elderly present greater morbidity and mortality, and although mortality is important and has been widely studied, morbidity may have implications such as loss of independence and the need for social support [13][14][15][16]. High FRAX index scores [5,6] were assessed as a predictor of mortality in Japanese haemodialysis patients [17], and the study concluded that the FRAX index seems to be useful in predicting mortality in these patients, especially men, after adjusting for confounding variables. We have found no studies of the relationship between the FRAX index and the BI/MMSE.…”

Chronic kidney disease and fragility fracture

“…Japanese dialysis patients demonstrated relatively better life prognosis after HFx [25]. However, FRAX, a tool to predict future fracture risk, can predict the risk of mortality even in Japan [26]. …”

Molecular Abnormalities Underlying Bone Fragility in Chronic Kidney Disease

“…Japanese dialysis patients, however, have relatively better prognosis with regard to survival after a hip fracture [13]. A tool called FRAX® that can predict fracture risk appears to be useful for predicting death among Japanese hemodialysis patients [14]. Even though it remains unclear why FRAX was useful to predict mortality in Japanese dialysis patients, elucidation of the pathogenesis of decreased bone strength and treatment of fractures in patients with CKD are important to improve survival and the quality of life in this patient population.…”