Abstract: SA-PO911

Risk Factors of Fragility Fracture 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

  • Kleman, Mark A., Geisinger Health System, Danville, Pennsylvania, United States
  • Zafar, Waleed, Geisinger, Dnville, Pennsylvania, United States
  • Chang, Alex R., Geisinger Medical Center, Danville, Pennsylvania, United States
Background

Management of chronic kidney disease-mineral and bone disorder (CKD-MBD) focuses mainly on parathyroid hormone (PTH), phosphorus, and calcium. However, little is known about fragility fracture risk factors in CKD patients.

Methods

The study population included 5,733 patients in the Geisinger Health System with CKD [estimated glomerular filtration rate (eGFR) < 60 ml/min/1.73m2, or urine albumin/creatinine ratio >=30 mg/g], intact PTH measurements, and no prior history of fragility fracture or use of osteoporosis medications. Fragility fracture was defined by ICD-9 codes for wrist, humerus, hip, and clinical spine fracture.

Results

Over a median follow-up of 5.0 (3.4-7.5) years, 609 (10.6%) CKD patients experienced an incident fragility fracture. Median (interquartile range) values for age, eGFR, intact PTH, alkaline phosphatase (ALP) were 70 (60-78) y, 43 (31-54) ml/min/1.73m2, 57 (37-90) pg/ml, and 77 (63-97) IU/L. and 68.0 y, 52.7% were female, 98.1% were white, mean eGFR was 44.8 (22.1) mL/min/1.73m2, and median Elevated alkaline phosphatase (ALP) >= 100 IU/L was associated with increased risk of incident fragility fracture; intact PTH, 25-hydroxyvitamin D, serum phosphorus and bicarbonate levels were not. Other significant risk factors included older age, female gender, body mass index (BMI) < 20 kg/m2, serum albumin < 4 g/dl, and history of non-fragility fracture (Table).

Conclusion

Several routinely collected clinical factors are associated with increased risk of fragility fracture in patients with CKD. Future clinical trials aimed at improving bone health and reducing fracture risk may consider using clinical factors to identify CKD patients at high risk of fragility fracture.

 HRP value
Age (per 1-y increase)1.04 (1.03-1.05)<0.001
Female1.36 (1.12-1.67)0.002
White2.47 (0.79-7.71)0.1
Current smoker1.16 (0.82-1.64)0.4
BMI <20 kg/m22.23 (1.42-3.50)0.001
Hx Stroke1.18 (0.95-1.47)0.1
Hx non-fragility fracture1.56 (1.21-2.01)0.001
ALP >= 100 IU/L1.31 (1.05-1.60)0.02
Intact PTH >= 130 pg/ml1.19 (0.89-1.60)0.2
Serum albumin < 4 g/dl1.55 (1.26-1.91)<0.001
Estrogen medications0.52 (0.26-1.06)0.07
DBP <60 mmHg1.34 (1.00-1.79)0.05
C Statistic0.68