Hip and Non-vertebral Fractures Risk Higher in Patients with Chronic Kidney Disease

Sarfaroj Khan 

July 23, 2020


  • Patients with moderate-to-severe chronic kidney disease (CKD) glomerular filtration rate (GFR) categories 3a-5D (G3a-G5D) are at an increased risk of hip and non-vertebral fractures compared with those without CKD G3a-G5D.

  • The risk of hip fracture is higher in the younger (<65 years) than the older population (>65 years) and increases progressively with loss of GFR.

Why this matters

  • Findings suggest that fracture prevention should be considered in patients with CKD at any age.

Study design

  • 14 studies met eligibility criteria.

  • Hip fracture analysis (10 studies; 250,440,035 participants; 5,798,566 with CKD G3a-G5D and 363,410 with fractures).

  • Non-vertebral fracture analysis (4 studies; 1,396,976 participants; 464,978 with CKD G3a-G5D and 115,284 fractures).

  • Funding: Amgen Inc.

Key results

  • Patients with CKD G3a-G5D vs those without had an increased risk of both hip fractures (relative risk [RR], 2.36; 95% CI, 1.64-3.39; I2, 99.8%) and non-vertebral fractures (RR, 1.47; 95% CI, 1.15-1.88; I2, 99.1%).

  • The risk of hip fracture was higher in younger (<65 years: RR, 7.66; 95% CI, 2.76-21.26) than older patients (>65 years: RR, 2.11; 95% CI, 1.41-3.16).

  • The risk of hip fracture was similar in women (RR, 2.42; 95% CI, 1.43-4.08) and men (RR, 2.64; 95% CI, 1.61-4.34).

  • The risk of fractures progressively increased with the decline in GFR:

    • CKD G3 (RR, 1.66; 95% CI, 1.13-2.44);

    • CKD G4 (RR, 2.62; 95% CI, 1.48-4.63); and

    • CKD G5D (RR, 4.17; 95% CI, 2.83-6.15).


  • Heterogeneity among studies.

  • Study did not explore the effect of different causes of CKD on the risk of fractures.


Vilaca T, Salam S, Schini M, Harnan S, Sutton A, Poku E, Allen IE, Cummings SR, Eastell R. Risks of Hip and Nonvertebral Fractures in Patients With CKD G3a-G5D: A Systematic Review and Meta-analysis. Am J Kidney Dis. 2020 Jul 9 [Epub ahead of print]. doi: 10.1053/j.ajkd.2020.02.450. PMID: 32654892 Abstract.  

This clinical summary first appeared on Univadis, part of the Medscape Professional Network.


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