Epidemiological study of orthopedic injuries in hemodialysis patients in Taiwan: a fixed cohort survey, 2004–2008

Abstract

BackgroundThe burden of chronic kidney disease (CKD) is a growing concern worldwide. The prevalence of hemodialysis in Taiwan is the highest in the world, and this may increase the prevalence of orthopedic fractures. The aim of this study was to explore the incidences of various orthopedic injuries and the related risk factors.MethodsA nationwide prospective study based on the Taiwan National Health Insurance dataset was conducted during 2004–2008. A total of 82,491 CKD patients were selected as the fixed cohort population. The International Classification of Diseases 9-CM diagnosis codes and treatment codes were identified as the inclusion criteria for orthopedic injury.ResultsA total of 82,491 Taiwanese people with CKD were identified in 2004, and 4915 orthopedic injuries occurred during the 5-year follow-up period. The cumulative incidences of orthopedic injuries were 42.56‰ for lower limb fractures, and 12.93‰, 3.27‰, and 1.64‰ for upper limb fractures, vertebrae fractures, and joint dislocations, respectively. All three types of orthopedic fractures were more common in the oldest age stratum (≥65 years old). In the CKD patients, the risk ratio of osteoporosis was 3.47 (95% confidence interval, 3.10–3.89) for all orthopedic injuries. Patients of advanced age, the female gender, and those with high comorbidity were also at significant risk of sustaining orthopedic fractures.ConclusionThe results from this Taiwanese CKD cohort support the strong influence of aging and osteoporosis on all kinds of orthopedic injuries. The postponing of osteoporosis may need to be taken into consideration for the prevention of orthopedic injury among CKD patients undergoing hemodialysis.

Fracture Risk in Dialysis and Kidney Transplanted Patients: A Systematic Review

“…Seven studies reported an incidence rate of overall fracture from an administrative database compared with 9 studies from a cohort or a clinical registry. From administrative databases, the incidences of overall fracture reported in 2 HD group studies were similar to those reported in 5 KT group studies (Fig. C ).…”

“…In studies evaluating the incidence or prevalence of hip, vertebral, or overall fracture in HD, PD, KT, or dialysis, the majority were at critical risk of bias when evaluating fracture . Five studies were at serious risk of bias, 1 study had no information, and another study was at moderate risk.…”

Osteoprotective effects of osthole in a mouse model of 5/6 nephrectomy through inhibiting osteoclast formation

“…In particular, of those aged ≥70 years, only 26% had normal kidney function (11). Almost 6% of patients with CKD suffer from fractures in 5-year-follow up, and this rate is higher in elderly patients (12). Patients with end-stage renal disease in their 40s have an 80-fold higher risk of hip fracture compared with that of age and gender-matched controls (13).…”

Perioperative Implications of End-stage Renal Disease in Orthopaedic Surgery

“…5 Lower extremity fractures are particularly common, and studies have shown a relative risk of hip fracture to be 4.4 to 17 times greater in the general elderly population and up to 100 times higher than the comparative population in younger patients. A Taiwanese prospective cohort study of .80,000 patients with ESRD reported a 5-year cumulative fracture risk of 59.6 per 1,000 persons and an incidence 1.72 times higher than the normal population.…”

“…5 Lower extremity fractures are particularly common, and studies have shown a relative risk of hip fracture to be 4.4 to 17 times greater in the general elderly population and up to 100 times higher than the comparative population in younger patients. 5,7 Steroid use, postmenopausal osteopenia, hypogonadism, and inactivity contribute to an increased prevalence of osteoporosis in patients with ESRD, which further increases the risk of fracture. 11 Fractures are generally low energy and occur as a result of falls.…”