Abstract: SA-PO888

FRAX® Predicts Fracture Risk in Patients with CKD

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

  • Whitlock, Reid, University of Manitoba, Winnipeg, Manitoba, Canada
  • Leslie, William, St Boniface General Hospital, Winnipeg, Manitoba, Canada
  • Shaw, James A., University of Manitoba, Winnipeg, Manitoba, Canada
  • Rigatto, Claudio, University of Manitoba, Winnipeg, Manitoba, Canada
  • Komenda, Paul, University of Manitoba, Winnipeg, Manitoba, Canada
  • Collister, David Thomas, University of Manitoba, Winnipeg, Manitoba, Canada
  • Tangri, Navdeep, University of Manitoba, Winnipeg, Manitoba, Canada
Background

FRAX® was developed to predict fracture risk in the general population but its applicability to patients with chronic kidney disease (CKD) is unknown.

Methods

Using the Manitoba Bone Mineral Density (BMD) Database, we identified adults not receiving dialysis services with serum creatinine measurements and bone densitometry within 1 year between 2005-2010. Estimated glomerular filtration rate (eGFR) was calculated using the Chronic Kidney Disease Epidemiology Collaboration equation. Incident major osteoporotic fractures (MOF) and hip fractures were ascertained from population-based healthcare databases. The performance of FRAX, derived without and with BMD, was studied in relation to CKD stage.

Results

We studied N=10,099 subjects (mean age 64 ± 13 y), including N=2154 with GFR 30-60 mL/min/1.73 m2 (CKD stage 3) and N=590 with GFR <30 mL/min/1.73 m2 (CKD stages 4-5). During a 5 year observation period, there were 772 individuals with an incident MOF and 226 with incident hip fractures. In Cox proportional hazards models, FRAX predicted risk for MOF and hip fracture in all eGFR strata. For every standard deviation increase in FRAX score derived with BMD, the HR for hip fracture was 4.54 (95% CI 3.57-5.77) in those with eGFR ≥ 60 mL/min/1.73m2, 4.52 (95% CI 3.15-6.49) in individuals with eGFR 30-60 mL/min/1.73m2, and 3.10 (95% CI 1.80-5.33) in individuals with eGFR <30 mL/min/1.73m2. HRs for MOF were lower than the equivalent hip fracture HRs in all eGFR categories, but greater for MOF in those with moderate and severe reductions in eGFR (FRAX*eGFR interaction P<0.001)

Conclusion

FRAX stratifies fracture risk in patients with moderate to severe CKD as well as in those with preserved eGFR. These findings support the use of the FRAX score to risk stratify patients with CKD for hip and major osteoporotic fractures.

Funding

  • Government Support - Non-U.S.