Increased risk of mortality associated with hip fracture in the dialysis population

Mittalhenkle, Anuja; Gillen, Daniel L.; Stehman‐Breen, Catherine

doi:10.1053/j.ajkd.2004.07.001

Cited by 142 publications

(75 citation statements)

References 26 publications

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“…Numerous studies have demonstrated increased fracture rates in adults with ESRD [8][9][10][11][12][13][14][15][16][17] and CKD. [20][21][22][23][24][25][26][27][28][29][30][31] With 90% of peak skeletal mass accrued by age 18, children with CKD are uniquely vulnerable to its multiple threats to bone health, but the The total n exceeds 67 first fracture events as there were fractures involving multiple sites.…”

Section: Discussionmentioning

confidence: 99%

“…7 It is well established that adults with ESRD have a substantially increased risk of fracture and associated morbidity and mortality. [8][9][10][11][12][13][14][15][16][17] In a study using the United States Renal Data System, Alem et al found that compared with healthy controls, young adults on hemodialysis had a 100-fold higher hip fracture rate. 9 In a population-based Dutch cohort of 247 adults with a history of ESRD at #14 years of age, 89% had osteopenia, 37% had clinical symptoms of bone disease, and 18% were disabled by bone disease.…”

mentioning

confidence: 99%

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Fracture Burden and Risk Factors in Childhood CKD

Denburg

Kumar

Jemielita

et al. 2016

Journal of the American Society of Nephrology

110

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Childhood chronic kidney disease (CHD) poses multiple threats to bone accrual; however, the associated fracture risk is not well characterized. This prospective cohort study included 537 CKD in Children (CKiD) participants. Fracture histories were obtained at baseline, at years 1, 3, and 5 through November 1, 2009, and annually thereafter. We used Cox regression analysis of first incident fracture to evaluate potential correlates of fracture risk. At enrollment, median age was 11 years, and 16% of patients reported a prior fracture. Over a median of 3.9 years, 43 males and 24 females sustained incident fractures, corresponding to 395 (95% confidence interval [95% CI], 293-533) and 323 (95% CI, 216-481) fractures per 10,000 person-years, respectively. These rates were 2-to 3-fold higher than published general population rates. The only gender difference in fracture risk was a 2.6-fold higher risk in males aged $15 years (570/10,000 person-years, adjusted P=0.04). In multivariable analysis, advanced pubertal stage, greater height Z-score, difficulty walking, and higher average log-transformed parathyroid hormone level were independently associated with greater fracture risk (all P#0.04). Phosphate binder treatment (predominantly calcium-based) was associated with lower fracture risk (hazard ratio, 0.37; 95% CI, P=0.03). Participation in more than one team sport was associated with higher risk (hazard ratio, 4.87; 95% CI, 2.21-10.75; P,0.001). In conclusion, children with CKD have a high burden of fracture. Regarding modifiable factors, higher average parathyroid hormone level was associated with greater risk of fracture, whereas phosphate binder use was protective in this cohort.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Fracture Burden and Risk Factors in Childhood CKD

Denburg

Kumar

Jemielita

et al. 2016

Journal of the American Society of Nephrology

110

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“…The risk has been estimated to be 4.4 to 14 times greater than that of the general population (1,2). Moreover, hip fracture is associated with a substantial increase in mortality in the ESRD population (1,2).…”

Section: H Ip Fracture Is Very Common In Patients With Esrdmentioning

confidence: 99%

“…Moreover, hip fracture is associated with a substantial increase in mortality in the ESRD population (1,2). Although the associations and risk factors for hip fracture in patients with ESRD are widely known (2)(3)(4)(5), considerably less information is available on the risk for hip fracture in patients with less severe chronic kidney disease (CKD).…”

Section: H Ip Fracture Is Very Common In Patients With Esrdmentioning

confidence: 99%

Relationship between Moderate to Severe Kidney Disease and Hip Fracture in the United States

Nickolas

McMahon

Shane

2006

Journal of the American Society of Nephrology

344

227

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People with ESRD are at a high risk for hip fracture. However, the effect of moderate to severe chronic kidney disease (CKD) on hip fracture risk has not been well studied. As part of the Third National Health and Nutrition Examination Survey, information on both kidney function and history of hip fracture was obtained. This survey is a complex, multistage, probability sample of the US noninstitutionalized civilian population and was conducted between 1988 and 1994. A history of hip fracture was identified from the response to a questionnaire that was administered to all participants. There were 159 cases of hip fracture. There was a significantly increased likelihood of reporting a hip fracture in participants with estimated GFR <60 ml/min (odds ratio [OR] 2.12; 95% confidence interval [CI] 1.18 to 3.80). In younger participants (aged 50 to 74 yr), the prevalence of CKD was approximately three-fold higher in those with a history of hip fracture versus in those without a history of hip fracture (19.0 versus 6.2%, respectively; P ‫؍‬ 0.04). In multivariate logistic regression analysis, only the presence of CKD (OR 2.32; 95% CI 1.13 to 4.74), a reported history of osteoporosis (OR 2.52; 95% CI 1.08 to 5.91), and low physical activity levels (OR 2.10; 95% CI 1.03 to 4.27) were associated with a history of hip fracture. There is a significant association between hip fracture and moderate to severe degrees of CKD, particularly in younger individuals, that is independent of traditional risk factors for hip fracture.

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“…42,44 Thus there is the possibility that calcification itself increases plaque burden by further activating pro- 26 we have observed a significant increase in circulating alkaline phosphatase in these mice (data not shown). Recently, osteoporosis has been identified as an independent risk factor for mortality in renal patients 45 who are also at increased risk for cardiovascular disease. 46 In a subset of mice we did not observe differences in serum phosphate or calcium (data not shown).…”

Section: Bennett Et Al Opg Atherosclerosis and Calcificationmentioning

confidence: 99%

Osteoprotegerin Inactivation Accelerates Advanced Atherosclerotic Lesion Progression and Calcification in Older ApoE ^−/− Mice

Bennett

Scatena

Kirk

et al. 2006

ATVB

285

206

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Objective-Osteoprotegerin (OPG), a member of the tumor necrosis factor (TNF) superfamily of proteins, plays an important role in bone remodeling and is expressed in both mouse and human atherosclerotic lesions. The current study was designed to assess whether OPG plays a role in the progression and calcification of advanced atherosclerotic lesions in apoE Ϫ/Ϫ mice. Methods and Results-Atherosclerotic lesion area and composition and aortic calcium content were examined in mice deficient in both OPG and apolipoprotein E (OPG Ϫ/Ϫ .apoE Ϫ/Ϫ mice) at 20, 40, and 60 weeks of age. Littermate OPG ϩ/ϩ .apoE Ϫ/Ϫ mice were used as controls. The average cross-sectional area of lesions in the innominate arteries was increased in OPG Ϫ/Ϫ .apoE Ϫ/Ϫ mice at 40 and 60 weeks of age. The increase in lesion area was coupled with a reduced cellularity and an increase in connective tissue including laminated layers of elastin. Sixty-week-old OPG Ϫ/Ϫ .apoEmice also had an increase in the area of calcification of the lesions. There were no differences in markers of plaque stability. In vitro, OPG induced matrix metalloproteinase-9 (MMP-9) activity in macrophages and smooth muscle cells and acted as a survival factor for serum-deprived smooth muscle cells. Conclusion-OPG inhibits advanced plaque progression by preventing an increase in lesion size and lesion calcification.OPG may act as a survival factor and may modulate MMP9 production in vascular cells.

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Increased risk of mortality associated with hip fracture in the dialysis population

Cited by 142 publications

References 26 publications

Fracture Burden and Risk Factors in Childhood CKD

Fracture Burden and Risk Factors in Childhood CKD

Relationship between Moderate to Severe Kidney Disease and Hip Fracture in the United States

Osteoprotegerin Inactivation Accelerates Advanced Atherosclerotic Lesion Progression and Calcification in Older ApoE ^−/− Mice

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Increased risk of mortality associated with hip fracture in the dialysis population

Cited by 142 publications

References 26 publications

Fracture Burden and Risk Factors in Childhood CKD

Fracture Burden and Risk Factors in Childhood CKD

Relationship between Moderate to Severe Kidney Disease and Hip Fracture in the United States

Osteoprotegerin Inactivation Accelerates Advanced Atherosclerotic Lesion Progression and Calcification in Older ApoE −/− Mice

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Product

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Osteoprotegerin Inactivation Accelerates Advanced Atherosclerotic Lesion Progression and Calcification in Older ApoE ^−/− Mice