Increased Risk of Hip Fracture Among Men With CKD

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.

Index Words: Bone metabolism, hip fracture, kidney disease, epidemiology