Patients receiving chronic hemodialysis treatments are at a higher risk of fracture compared to the general population. While the use of heparin during dialysis is crucial to avoid thrombosis of the extracorporeal circuit, the association of unfractionated heparin (UFH) and the risk of osteoporotic fracture has been shown for many years. However, this association was not as clear for low-molecular-weight heparin (LMWH) and the few collected data originated from studies among pregnant women. Our aim was to measure osteoporotic fracture rate among hemodialysis patients and to evaluate the association of LMWH compared to UFH in hemodialysis. A retrospective cohort study was conducted on data extracted from the RAMQ and Med-Echo databases from January 2007 to March 2013 with patients chronically hemodialyzed in 21 participating centers. Incidence rates for each fracture sites were measured per 1000 patient-year (p-y) and their 95% confidence intervals (CI). Osteoporotic fracture risk for a first event with LMWH compared to UFH was estimated using a cox proportional hazard model using demographics, comorbidities and drug use as covariates. 4796 patients undergoing chronic hemodialysis were identified. The incidence rate for all fracture sites was 22.7 /1000 p-y (95% CI: 19.6–26.1) and 12.8 /1000 p-y (95% CI: 10.5–15.4) for hip and femur fractures. We found a similar risk of osteoporotic fracture for LMWH compared to UFH (adjusted HR = 1.01; 95%CI: 0.72–1.42). Age and malignancy increased the risk of fracture while cerebrovascular disease decreased the risk of fracture. Compared to UFH, LMWH did not change the risk of osteoporotic fracture when used for the extracorporeal circuit anticoagulation in chronic hemodialysis.

中文翻译：

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慢性血液透析中的骨质疏松性骨折率和肝素暴露的影响：一项回顾性队列研究。

与一般人群相比，接受慢性血液透析治疗的患者发生骨折的风险更高。虽然在透析期间使用肝素对于避免体外回路血栓形成至关重要，但多年来，普通肝素 (UFH) 与骨质疏松性骨折风险之间的关联已被证明。然而，这种关联对于低分子量肝素 (LMWH) 而言并不那么明确，而且收集的少数数据来源于对孕妇的研究。我们的目的是测量血液透析患者的骨质疏松性骨折率，并评估 LMWH 与 UFH 在血液透析中的关联。对 2007 年 1 月至 2013 年 3 月从 RAMQ 和 Med-Echo 数据库中提取的数据进行了一项回顾性队列研究，这些数据涉及 21 个参与中心的慢性血液透析患者。每 1000 患者年 (py) 及其 95% 置信区间 (CI) 测量每个骨折部位的发生率。使用人口统计学、合并症和药物使用作为协变量的 cox 比例风险模型估计了 LMWH 与 UFH 相比首次事件的骨质疏松性骨折风险。确定了 4796 名接受慢性血液透析的患者。髋部和股骨骨折的所有骨折部位的发生率为 22.7 /1000 py（95% CI：19.6-26.1）和 12.8 /1000 py（95% CI：10.5-15.4）。我们发现与 UFH 相比，LMWH 的骨质疏松性骨折风险相似（调整后的 HR = 1.01；95% CI：0.72–1.42）。年龄和恶性肿瘤增加骨折风险，而脑血管疾病降低骨折风险。与和睦家相比，