Abstract: SA-PO905

Risk of Fracture in Glomerular Disease: A Population-Based Cohort Study Using the Health Improvement Network

Session Information

  • Mineral Disease: CKD-Bone
    November 04, 2017 | Location: Hall H, Morial Convention Center
    Abstract Time: 10:00 AM - 10:00 AM

Category: Mineral Disease

  • 1203 Mineral Disease: CKD-Bone

Authors

  • Denburg, Michelle, The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, United States
  • Mariani, Laura H., University of Michigan, Ann Arbor, Michigan, United States
  • Glenn, Dorey A., University of North Carolina, Chapel Hill, North Carolina, United States
  • Copelovitch, Lawrence A., The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, United States
  • Leonard, Mary B., Stanford School of Medicine, Stanford, California, United States
  • Nickolas, Thomas, Columbia University Medical Center, New York, New York, United States
Background

Current understanding of skeletal complications in glomerular disease (GD) is limited. To our knowledge, there have been no studies in children or adults addressing the risk of fracture associated with GD independent of kidney function.

Methods

We performed a population-based retrospective cohort study using The Health Improvement Network. The median calendar year at the start of observation was 2005 (1994-2015). We identified 16,111 patients with ≥1 of 155 diagnostic codes for primary GD and 161,045 randomly selected age, sex, and practice-matched individuals. Exclusion criteria included age ≥90 years, systemic lupus or vasculitis, multiple myeloma, amyloidosis, inflammatory bowel disease, celiac disease, HIV, hepatitis B or C, malignancy, and non-renal solid organ transplant. Cox regression was used to estimate the hazard ratio (HR) for first fracture.

Results

Median age was 42 years, and 57% were male. Over a median observation period of 5 years, 1328 incident fractures (132 per 10,000 person-years) occurred in participants with GD versus 11,423 in those without GD (110 per 10,000 person-years). In multivariable analysis adjusted for age, sex, and diabetes and chronic kidney disease (stage 3-5D and/or renal transplant) as time-varying covariates, GD was associated with an increased risk of fracture (HR 1.13; 95% CI: 1.06, 1.19, p<0.001). The adjusted HR for first incident vertebral fracture was 1.47 (95% CI: 1.10, 1.95, p=0.009). The adjusted HR for first incident hip/femur fracture was 1.46 (95%CI: 1.21, 1.75, p<0.001), and the increased risk associated with GD was more pronounced in younger individuals (HR 2.65 for those <40 years old vs. 1.42 for those ≥40 years, interaction p=0.03).

Conclusion

In this large-population based cohort study, GD was associated with an increased risk of incident fracture, particularly at the hip and spine, independent of impaired kidney function.

Funding

  • NIDDK Support