The three-year incidence of fracture in chronic kidney disease

Abstract

Knowing a person's fracture risk according to their kidney function, gender, and age may influence clinical management and decision-making. Using healthcare databases from Ontario, Canada, we conducted a cohort study of 679,114 adults of 40 years and over (mean age 62 years) stratified at cohort entry by estimated glomerular filtration rate ((eGFR) 60 and over, 45-59, 30-44, 15-29, and under 15 ml/min per 1.73 m 2 ), gender, and age (40-65 and over 65 years). The primary outcome was the 3-year cumulative incidence of fracture (proportion of adults who fractured (hip, forearm, pelvis, or proximal humerus) at least once within 3-years of follow-up). Additional analyses examined the fracture incidence per 1000 person-years, hip fracture alone, stratification by prior fracture, stratification by eGFR and proteinuria, and 3-year cumulative incidence of falls with hospitalization. The 3-year cumulative incidence of fracture significantly increased in a graded manner in adults with a lower eGFR for both genders and both age groups. The 3-year cumulative incidence of fracture in women over 65 years of age across the 5 eGFR groups were 4.3%, 5.8%, 6.5%, 7.8%, and 9.6%, respectively. Corresponding estimates for men over 65 years were 1.6%, 2.0%, 2.7%, 3.8%, and 5.0%, respectively. Similar graded relationships were found for falls with hospitalization and additional analyses. Thus, many adults with chronic kidney disease will fall and fracture. Results can be used for prognostication and guidance of sample size requirements for fracture prevention trials.

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.…”

“…38 Though not statistically significant after adjustment for PTH, the fully adjusted HR of 2.08 associated with a baseline eGFR,60 ml/min per 1.73 m 2 is highly consistent with findings in adults with CKD. In a recent study of .600,000 individuals $40 years of age, 30 the incidence rate ratio for fracture in 40-65-year-old year old men with an eGFR of 30-44 and 15-29 was 1.7 and 2.2, respectively, compared with the reference group with eGFR$60. Similarly, the rate ratio for fracture in 40-65-year-old women was 2.4 for both an eGFR of 30-44 and eGFR of 15-29 versus eGFR$60.…”

“…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.…”

High calcium diet alleviates 5/6 nephrectomy-induced bone deteriorations of lumbar vertebrae in mice

“…Previous clinical studies have demonstrated that the severity of CKD is associated with fracture rate (3,4). Dysregulated mineral homeostasis is a typical feature of CKD (3,4). Therefore, improving bone mineralization and microstructure in patients with CKD is necessary to reduce the risk of fracture.…”

“…In the progression of CKD, low glomerular filtration rate (GFR) is associated with excessive phosphorus (P) levels, which accelerate osteocyte-derived fibroblast growth factor-23 (FGF-23) and parathyroid hormone (PTH) secretion and adversely affects bone remodeling and resorption, eventually resulting in osteoporotic bone complications (2). Previous clinical studies have demonstrated that the severity of CKD is associated with fracture rate (3,4). Dysregulated mineral homeostasis is a typical feature of CKD (3,4).…”