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American Journal of Kidney Diseases

Hip Fracture Trends in Japanese Dialysis Patients, 2008-2013

Published:November 20, 2017DOI:https://doi.org/10.1053/j.ajkd.2017.07.017

      Background

      Contrary to observations of decreasing rates in Western nations for the past 2 decades, age-adjusted rates of hip fracture in the general population in Japan have continually increased. This study aimed to analyze recent changes in trends of hip fracture incidence among Japanese dialysis patients between 2008 and 2013.

      Study Design, Setting, & Participants

      Using data from the Japanese Society for Dialysis Therapy Renal Data Registry database from 2007 to 2013, we created a point-prevalent study cohort for each study year. Prevalent dialysis cohorts included patients 20 years or older without a history of hip fracture who were receiving maintenance dialysis in Japan on December 31 of each year.

      Factors

      Age, sex, and calendar year.

      Outcomes

      Hip fracture incidence rates.

      Measurements

      Unadjusted hip fracture rates were estimated using number of events per 1,000 patient-years in each year and then standardized for age to the 2013 dialysis population. Average annual percentage of change in rates and corresponding 95% CI were computed for trend by joinpoint regression analysis.

      Results

      During the study period, 6,615 and 4,963 hip fractures were recorded among female and male dialysis patients, respectively. Age-standardized hip fracture rates decreased steadily from 2008 (21.1/1,000 patient-years) to 2013 (17.7/1,000 patient-years) among women, but remained constant from 2008 (8.6/1,000 patient-years) through 2013 (8.2/1,000 patient-years) among men. Decreases in the joinpoint trend for hip fracture were significant among female (−3.6% [95% CI, −6.9 to −0.2] per year), but not among male, dialysis patients (−1.4% [95% CI, −5.7 to 3.0] per year) from 2008 through 2013.

      Limitations

      Only the first hip fracture event was considered in calculations of fracture rates.

      Conclusions

      In contrast to the increasing incidence of hip fracture in the general Japanese population, we found that the incidence of hip fracture in Japanese dialysis patients between 2008 and 2013 decreased among women, but did not change in men.

      Index Words

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      Linked Article

      • Declining Hip Fracture Rates in Dialysis Patients: Is This Winning the War?
        American Journal of Kidney DiseasesVol. 71Issue 2
        • Preview
          Fracture rates in patients with chronic kidney disease (CKD) are remarkably higher than in the general population.1-7 All studies of adults and children with CKD stages 3 and 4 on dialysis therapy and after kidney transplantation demonstrate that fracture incidence is 2- to 100-fold higher compared with age- and sex-matched individuals without CKD.1-3,7-10 Fracture incidence increases in a graded manner with more severely reduced kidney function,5 and even declines in estimated glomerular filtration rates have been demonstrated to predict future fracture.
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