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Abstract: TH-PO130

Risk Factors Associated with Hip and Vertebral Fractures in CKD: The Chronic Renal Insufficiency Cohort (CRIC) Study

Session Information

Category: Bone and Mineral Metabolism

  • 502 Bone and Mineral Metabolism: Clinical

Authors

  • Hsu, Simon, University of Washington, Seattle, Washington, United States
  • Zelnick, Leila R., University of Washington, Seattle, Washington, United States
  • Bansal, Nisha, University of Washington, Seattle, Washington, United States
  • Denburg, Michelle, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States
  • Ginsberg, Charles, University of California San Diego, La Jolla, California, United States
  • Hoofnagle, Andrew N., University of Washington, Seattle, Washington, United States
  • Isakova, Tamara, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States
  • Ix, Joachim H., University of California San Diego, La Jolla, California, United States
  • Kestenbaum, Bryan R., University of Washington, Seattle, Washington, United States
  • Robinson-Cohen, Cassianne, Vanderbilt University Medical Center, Nashville, Tennessee, United States
  • Wolf, Myles, Duke University School of Medicine, Durham, North Carolina, United States
  • de Boer, Ian H., University of Washington, Seattle, Washington, United States
Background

Fracture risk is substantially higher in patients with chronic kidney disease (CKD) than those without CKD and may have different pathophysiology, yet risk factors for fracture in CKD have largely been generalized from studies in non-CKD populations.

Methods

We used Cox regression to test associations of putative demographic and clinical risk factors with the composite hip and vertebral fracture assessed using hospital discharge diagnosis codes in 3,939 participants from the Chronic Renal Insufficiency Cohort (CRIC). Estimated glomerular filtration rate (eGFR) and proteinuria assessed by 24-hour urine collection were time-updated exposures. Serum 25-hydroxyvitamin D, 1,25-dihydroxyvitamin D, and 24,25-dihydroxyvitamin D3 were measured in a subset of 1,786 participants by liquid chromatography-tandem mass spectrometry.

Results

Mean cohort age was 58 years, 45% were female, 42% were Black, and 13% were Hispanic. Mean (standard deviation [SD]) eGFR was 44.4 (15.2). There were 82 hip and 24 vertebral fractures over a mean (SD) follow-up of 11.1 (4.8) years (incidence rate 2.4 events per 1000 person-years [95% CI: 2.0, 2.9]). Black race was associated with lower fracture risk after adjusting for demographics, comorbidity, medication use, and eGFR and proteinuria. Older age, lower body mass index, and lower eGFR were associated with higher fracture risk after full covariate adjustment. Neither proteinuria, parathyroid hormone, nor other biomarkers of mineral metabolism were associated with fracture risk after full covariate adjustment.

Conclusion

Older age, non-Black race, and lower body mass index and eGFR were associated with fracture risk. None of the biomarkers of mineral metabolism tested in this study were associated with elevated risk of fracture experienced by patients with CKD.

Funding

  • NIDDK Support