| アブストラクト | 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. |
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| 投稿者 | de Bruin, I J A; Wyers, C E; Souverein, P C; van Staa, T P; Geusens, P P M M; van den Bergh, J P W; de Vries, F; Driessen, J H M |
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| 組織名 | Department of Internal Medicine, VieCuri Medical Center, Venlo, The Netherlands.;NUTRIM School for Nutrition and Translational Research in Metabolism, Department;of Internal Medicine, Maastricht University Medical Centre+, Maastricht, The;Netherlands.;Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute of;Pharmaceutical Sciences, P.O. Box 80082, 3508 TB, Utrecht, The Netherlands.;Centre for Health Informatics, School of Health Sciences, Faculty of Biology,;Medicine and Health, The University of Manchester, Oxford Road, Manchester,;England.;Biomedical Research Center, Hasselt University, Diepenbeek, Belgium.;CAPHRI Care and Public Health Research Institute, Department of Internal;Medicine, Subdivision Rheumatology, Maastricht University Medical Centre+,;Maastricht, The Netherlands.;f.devries@uu.nl.;Department of Clinical Pharmacy and Toxicology, Maastricht University Medical;Centre+, Maastricht, The Netherlands. f.devries@uu.nl.;Cardiovascular Research Institute Maastricht, Maastricht University Medical;Centre+, Maastricht, The Netherlands.;NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht;University, Maastricht, The Netherlands. |
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