CKD and Risk of New Fragility Fractures Following First Hip Fracture

Sarfaroj Khan

April 17, 2020

Takeaway

  • Chronic kidney disease (CKD) stages G3-G5 (estimated glomerular filtration rate [eGFR],<60 ml/min) were not associated with a higher risk of subsequent major non-hip fragility fractures following a hip fracture vs eGFR >60 mL/min.

  • CKD stages G4 (eGFR 15–29 ml/min/1.73 m2) and G5 (eGFR<15 ml/min/1.73 m2) were associated with a higher risk of mortality.

Why this matters

  • The elevated mortality risk may as competing risk explain that CKD stages G3-G5 should not be considered as an important additional risk factor for subsequent fractures in this population.

Study design

  • This retrospective population-based cohort study included 37,820 patients with a hip fracture using data from the UK Clinical Practice Research Datalink GOLD.

  • Of 37,820 patients, 23,780 had CKD (13,047 with eGFR >60 mL/min and 10,733 with CKD stages G3-G5).

  • Funding: None disclosed.

Key results

  • Compared with eGFR >60 mL/min, CKD G3-G5 was associated with a lower risk of any subsequent non-hip fracture (HR, 0.90; 95% CI, 0.83-0.97), but not with the risk of subsequent major non-hip fragility fracture.

  • Patients with CKD stages G3-G5 were at a higher risk for mortality compared with those with eGFR >60 mL/min (cause-specific [cs] HR, 1.05; 95% CI, 1.01-1.09).

  • The risk for mortality was 1.5-fold to 3-fold higher in patients with CKD stages G4 (cs-HR, 1.50; 95% CI, 1.38-1.62) and G5 (cs-HR, 2.93; 95% CI, 2.48-3.46) vs those with eGFR >60 mL/min.

Limitations

  • Study included only community-dwelling patients.

 

de Bruin IJA, Wyers CE, Souverein PC, van Staa TP, Geusens PPMM, van den Bergh JPW, de Vries F, Driessen JHM. The risk of new fragility fractures in patients with chronic kidney disease and hip fracture-a population-based cohort study in the UK. Osteoporos Int. 2020 Apr 07 [Epub ahead of print]. doi: 10.1007/s00198-020-05351-x. PMID: 32266436.  View abstract 

This clinical summary first appeared on Univadis from Medscape.

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