Received 1 May 2007; accepted 30 August 2007. published online 31 October 2007.
Background
Patients with chronic kidney disease (CKD) have disturbances in mineral metabolism. Those requiring dialysis therapy are at substantially increased risk of fracture. However, fracture risk in patients with CKD not requiring dialysis has not been well studied.
Study Design
Retrospective cohort.
Setting & Participants
We identified men who sought care at 8 Veterans Affairs Medical Centers located in the Northwest from July 1999 to March 2006 who had a glomerular filtration rate (GFR) less than 60 mL/min/1.73 m2. Patients who received long-term dialysis therapy or had a previous organ transplant, diagnosis of cancer, or history of hip fracture were excluded. Proportional hazards models were used to estimate the association of GFR stage with relative risk of hip fracture.
Predictor
GFR estimated on the basis of 2 or more consecutively abnormal outpatient serum creatinine measurements during a 6-month period.
Outcome
Hip fracture ascertained from patient medical records.
Results
In 33,091 veterans, 176 hip fractures were identified. After adjustment for age, body mass index, diabetes, and use of selected medications, relative risks of hip fracture for men with a GFR of 30 to 59 and 15 to 29 mL/min/1.73 m2 were 1.28 (95% confidence interval, 0.88 to 1.66) and 3.98 (95% confidence interval, 2.25 to 7.74), respectively.
Limitations
Retrospective study of men only.
Conclusions
These results suggest that the risk of hip fracture in men with CKD stage 4 is increased to a degree similar to that of dialysis patients.
1Northwest Health Services Research and Development Program, Veterans Administration Puget Sound, University of Washington, Seattle, WA
2Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA
3Division of Nephrology, University of Washington, Seattle, WA.
Address correspondence to Bryan Kestenbaum, MD, MS, Department of Medicine/Division of Nephrology, University of Washington, Harborview Medical Center, Rm 10EH11.1, Box 359764, 325 9th Ave, Seattle, WA 98104-2499.
ABSTRACT