Summary

Chronic kidney disease (CKD) is a risk factor for fractures. However, in hip fracture patients, CKD G3-G5 was associated with a higher mortality risk and not associated with a higher risk of subsequent non-hip fractures compared to eGFR > 60 ml/min. The higher mortality risk may, as competing risk, explain our findings.

Introduction

Chronic kidney disease (CKD) is a known risk factor for fragility fractures. Patients aged 50+ with a recent fragility fracture have an increased risk of subsequent fractures. Our aim was to evaluate the association between CKD stages G3–G5 versus estimated glomerular filtration rate (eGFR) > 60 ml/min and the risk of a new non-hip fracture or fragility fracture in patients with a first hip fracture.

Methods

Population-based cohort study using the UK general practices in the Clinical Practice Research Datalink. Associations between CKD stage and first subsequent fracture were determined using Cox proportional hazard analyses to estimate hazard ratios (HRs). To explore the potential competing risk of mortality, cause-specific (cs) HRs for mortality were estimated.

Results

CKD G3–G5 was associated with a lower risk of any subsequent non-hip fracture (HR: 0.90, 95%CI: 0.83–0.97), but not with the risk of subsequent major non-hip fragility fracture. CKD G3-G5 was associated with a higher mortality risk (cs-HR: 1.05, 95%CI: 1.01–1.09). Mortality risk was 1.5- to 3-fold higher in patients with CKD G4 (cs-HR: 1.50, 95%CI: 1.38–1.62) and G5 (cs-HR: 2.93, 95%CI: 2.48–3.46) compared to eGFR > 60 ml/min.

Conclusions

The risk of a subsequent major non-hip fragility fractures following hip fracture was not increased in patients with CKD G3–G5 compared to eGFR > 60 ml/min. Mortality risk was higher in both hip fracture and non-hip fracture patients with CKD G4 and G5. The higher mortality risk may, as competing risk, explain our main finding of no increased or even decreased subsequent fracture risk after a hip fracture in patients with CKD G3–G5.

中文翻译：

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慢性肾病和髋部骨折患者发生新脆性骨折的风险——英国一项基于人群的队列研究。

 概括

慢性肾脏病（CKD）是骨折的危险因素。然而，在髋部骨折患者中，与 eGFR > 60 ml/min 相比，CKD G3-G5 与较高的死亡风险相关，但与后续非髋部骨折的较高风险无关。较高的死亡风险可能作为竞争风险解释了我们的发现。

 介绍

慢性肾脏病（CKD）是脆性骨折的已知危险因素。 50 岁以上近期发生脆性骨折的患者后续骨折的风险增加。我们的目的是评估 CKD G3-G5 期与估计肾小球滤过率 (eGFR) > 60 ml/min 之间的关系，与首次髋部骨折患者发生新发非髋部骨折或脆性骨折的风险之间的关系。

 方法

使用临床实践研究数据链中的英国一般实践进行基于人群的队列研究。使用 Cox 比例风险分析来估计风险比 (HR)，确定 CKD 分期与随后首次骨折之间的关联。为了探索潜在的死亡竞争风险，我们估计了死亡率的特定原因 (cs) HR。

 结果

CKD G3–G5 与任何后续非髋部骨折的较低风险相关（HR：0.90，95%CI：0.83–0.97），但与后续严重非髋部脆性骨折的风险无关。 CKD G3-G5 与较高的死亡风险相关（cs-HR：1.05，95%CI：1.01-1.09）。与 eGFR 相比，CKD G4（cs-HR：1.50，95%CI：1.38-1.62）和 G5（cs-HR：2.93，95%CI：2.48-3.46）患者的死亡风险高出 1.5 至 3 倍> 60 毫升/分钟。

 结论

与 eGFR > 60 ml/min 相比，CKD G3-G5 患者在髋部骨折后发生严重非髋部脆性骨折的风险并未增加。 CKD G4 和 G5 的髋部骨折和非髋部骨折患者的死亡风险较高。较高的死亡率风险作为竞争风险，可能解释了我们的主要发现，即 CKD G3-G5 患者髋部骨折后后续骨折风险没有增加甚至减少。