Study identifies CKD as risk factor for hip, nonvertebral fractures
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A review of published studies revealed hip and nonvertebral fracture risks increased for patients with chronic kidney disease stages G3a-G5D, leading researchers to suggest CKD be considered as an additional risk factor for fractures.
“CKD is associated with mineral and bone disorders (CKD-MBD),” Tatiane Vilaca, MD, of the department of oncology and metabolism at The University of Sheffield in the United Kingdom, and colleagues. “CKD-MBD may affect bone turnover, volume, mineralization, microstructure and mechanical properties. These abnormalities could affect bone quality and strength, predisposing to fractures independently of bone mineral density (BMD).”
Contending that evidence is lacking regarding the impact of reduced kidney function on fracture risk at various stages of CKD, the researchers conducted systematic review and meta-analysis of observational studies on the topic, looking specifically at hip and nonvertebral fracture risk in adults with decreased eGFR rates (eGFRs < 60 mL/min/1.73m2) compared with those without decreased eGFRs.
A total of 13 studies were included in the systematic review and 10 in the meta-analysis, with the researchers noting the studies had been conducted in a variety of regions including North America, Europe and Asia.
Results showed a significant increase in fracture risk for hip (relative risk [RR] = 2.36) and nonvertebral fractures (RR = 1.47) in patients with CKD G3a-G5D. Greater GFR loss was associated with a higher relative risk for fractures.
Additional findings indicated younger patients, defined as those younger than 65 years, had a higher relative risk for hip fracture than patients older than 65 years (RR = 7.66 vs. 2.11), with researchers speculating that CKD may play a significant role in the increased risk as fractures are not common in younger populations.
“Further studies are required to determine the exact fracture risk in more specific subgroups,” Vilaca and colleagues concluded. “Nonetheless, having CKD G3a-G5D should be considered an additional risk factor for fractures, beyond the traditional ones. Treatment indications and benefit, especially for more advanced CKD, remain unknown.”
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