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Hip fracture rates in ESRD declining
Adults with end-stage renal disease remain at risk for hip fracture despite a decline in rates of fracture and in-hospital mortality from 2003 to 2011, according to findings published in the Journal of Bone and Mineral Research.
Glenn M. Chertow, MD, MPH, of the department of medicine at Stanford University School of Medicine, and colleagues evaluated data from the 2003-2011 Nationwide Inpatient Sample on 47,510 adults with ESRD and 2,492,392 adults without ESRD to determine trends in age- and sex-standardized hip fracture rates and associated in-hospital mortality, length of hospital stay and costs.
In participants with ESRD, hip fracture rates declined by 15.3% from 2003 to 2011 in adults at least 65 years of age, and rates decreased more rapidly in older women compared with older men. Hip fracture rates declined by 23.9% from 2003 to 2011 in women aged at least 65 years with ESRD.
In participants without ESRD, hip fractures were relatively uncommon in participants younger than 65 years, and rates were highest in older women. Rates of hip fracture declined more steeply in older women compared with older men, especially in those aged at least 85 years.
In-hospital mortality rates were higher in the ESRD group (7.3%) compared with the non-ESRD group (2.1%). In-hospital mortality rates declined by 26.7% from 2003 to 2011 in the ESRD group; however, the rates among the ESRD group were more than three times higher (6.3%) than in the non-ESRD group in 2011 (1.9%). Odds of in-hospital mortality after hip fracture operation were also significantly higher in the ESRD group compared with the non-ESRD group after adjustment for age, sex, hospital characteristics and several comorbid conditions (OR = 5.9; 95% CI, 5.08-6.86).
Length of hospital stay was longer in the ESRD group (median, 7 days) compared with the non-ESRD group (median, 5 days), but length of stay steadily decreased over time in both groups. Median hospital costs were higher in the ESRD group ($16,219) compared with the non-ESRD group ($11,991), and costs increased more rapidly over time in the ESRD group compared with the non-ESRD group (P for interaction < .001).
“Despite these encouraging trends, hip fracture rates in ESRD remain extremely high, and associated morbidity is considerable,” the researchers wrote. “New strategies (pharmacologic and otherwise) are required to further reduce hip fracture rates and rates of associated complications in this high-risk population.” – by Amber Cox
Disclosure: Chertow reports receiving research support from Amgen.