Kidney Week

Abstract: FR-PO0981

Fracture Risk Associated with Estrogen-Progesterone Therapy in Young Women with CKD: A Real-World Cohort Study

Session Information

• Top Trainee Posters - 2
  October 23, 2026 | Location: Exhibit Hall A, Convention Center
  Abstract Time: 01:12 PM - 01:18 PM

Category: Women's Health and Kidney Diseases

• 2100 Women's Health and Kidney Diseases

Authors

• Pollock, Netanya, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States

Netanya Pollock, MD, MS

• Zee, Jarcy, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States

Jarcy Zee, PhD, FASN

• Copelovitch, Lawrence A., The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States

Lawrence A. Copelovitch, MD

• Leonard, Mary B., Lucile Salter Packard Children's Hospital at Stanford General Pediatrics, Palo Alto, California, United States

Mary B. Leonard, MD, MS

• Mostoufi-Moab, Sogol, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States

Sogol Mostoufi-Moab, MD

• Denburg, Michelle, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States

Michelle Denburg, MD

Background

Females with chronic kidney disease (CKD) are at increased risk for skeletal fragility and fractures. Combined estrogen/progesterone (E/P) therapy is commonly prescribed in reproductive-aged women for contraception, menstrual regulation, and hormone replacement. Data regarding the skeletal effects of E/P in the general population are conflicting, and the association of E/P with fractures in CKD is poorly understood. We evaluated the association between E/P and incident fractures in reproductive-aged women with moderate-severe CKD.

Methods

Using electronic health record data from the TriNetX Network, we identified females aged 12-40 years (y) with stage 3-5D CKD and no prior E/P use. Eligible patients required >180 days of follow-up after cohort entry. Patients with contraindications to E/P use were excluded. Incident fractures of the spine, upper arm, forearm, hip/femur/pelvis, or lower leg were identified using diagnosis codes. Propensity score nearest-neighbor matching (1:5 with replacement) balanced baseline characteristics. A pooled logistic model approximated a Cox model to estimate hazard ratios (HRs) and 95% confidence intervals (CIs). Robust standard errors accounted for clustering and inverse probability of censoring weights for treatment discontinuation/switch.

Results

Among 36,289 eligible patients, 1,286 combined E/P users were matched to 4,850 unique nonusers. During median follow-up of 3.2y (IQR 1.4 – 6.0), fracture incidence rates were 12.8 (95% CI 8.4 – 18.8) and 9.3 (95% CI 8.1 – 10.6) per 1,000 person-years among hormone users and nonusers, respectively. E/P was associated with higher fracture risk (adjusted HR 1.5, 95% CI 1.0 – 2.3). In exploratory analysis, associations appeared stronger at younger ages (p-interaction=0.056). Among users of ethinyl estradiol-containing combined oral contraceptives, low-dose formulations (≤20 mcg) showed higher fracture hazard than higher-dose (>20 mcg), though estimates were imprecise due to limited events.

Conclusion

In this real-world cohort study of reproductive-aged women with CKD, E/P therapy was associated with higher incident fracture risk. Exploratory analyses suggested possible differences by estrogen dose and age. Further studies accounting for treatment indication, formulation, dose, and endogenous ovarian function are needed to clarify causality and guide hormone management.