Hip and non-vertebral fractures risk higher in patients with chronic kidney disease

  • Vilaca T & al.
  • Am J Kidney Dis
  • 9 Jul 2020

  • curated by Sarfaroj Khan
  • UK Clinical Digest
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Takeaway

  • 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) 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, 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).

Limitations

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