Association of Kidney Function with Incident Hip Fracture in Older Adults

Abstract

Kidney dysfunction is associated with bone loss, and patients with ESRD have an increased risk for hip fracture. However, the association of mild to moderate kidney disease with hip fracture has not been studied previously. The association of kidney function with incident hip fracture was examined among participants in the Cardiovascular Health Study, a community-based cohort of older individuals. The primary measure of kidney function was serum cystatin C, a measure that does not depend on lean mass. Hip fractures were identified using International Classification of Diseases, Ninth Revision codes for hospitalizations. A total of 4699 individuals had cystatin C measured in 1992 to 1993 and did not have a hip fracture before cystatin C measurement. The association of kidney function with hip fracture was analyzed with Cox proportional hazards models. Analyses were conducted separately for men and women. After a mean follow-up of 7.1 yr, 195 incident hip fractures occurred in women and 79 occurred in men. Higher cystatin C levels were associated with a higher risk for fracture in women (hazard ratio [HR] 1.26; 95% confidence interval [CI] 1.14 to 1.38 per SD) and in men (HR 1.27; 95% CI 1.11 to 1.46). After multivariable adjustment, higher cystatin C levels were significantly associated with hip fracture in women (HR 1.16; 95% CI 1.01, 1.33) but not in men (HR 1.14; 95% CI 0.86 to 1.52), although the magnitude of the association was similar. Kidney dysfunction, as assessed by cystatin C, is associated with an increased risk for hip fracture. Further studies are needed to evaluate potential mediators of this relationship and to assess whether interventions can decrease this risk.

Efficacy and Safety of Denosumab for the Treatment of Osteoporosis in Patients with Chronic Kidney Disease

“…Nickolas et al reported an independent correlation between an eGFR <60 mL/min/1.73 m 2 and the prevalence of hip fractures [21]. In addition, elevated serum cystatin C levels have been independently associated with risk for hip fracture [22,23].…”

Timing of Onset of CKD-Related Metabolic Complications

“…4 -6 Early detection of CKD and its metabolic complications is now a priority for delaying disease progression and for primary prevention of many CKD-associated chronic diseases, including cardiovascular, mineral, and bone diseases 5,[7][8][9] ; however, data on the natural history of these complications according to reference methods are sparse, and there is little evidence about the most appropriate timing for their detection.…”

Discriminants of Prevalent Fractures in Chronic Kidney Disease

“…[1][2][3] Cross-sectional data suggest fracture risk increases as kidney function declines and by CKD stage 4 approximates that for ESRD. 2 Furthermore, fracture-related mortality for patients with predialysis CKD is approximately twofold higher than the general population.…”

“…Bone quality is related to other material properties of the skeleton, including bone microarchitecture and remodeling activity. Microarchi- 3 ) and microarchitecture of the distal skeleton (radius and tibia). Bone remodeling can also be assessed with reasonable accuracy by measurement of bone turnover markers (BTMs) in patients with normal kidney function.…”