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Published on: January 29, 2018
Bone mineral density and fracture risk in older individuals with CKD
Robert H Yenchek1, Joachim H Ix, Michael G Shlipak
1Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA. yenchekrh@upmc.edu
Insights
Bone mineral density (BMD) predicts fracture risk in older adults, even those with chronic kidney disease (CKD). This finding challenges current guidelines recommending against BMD screening in CKD patients.
Area of Science:
- Gerontology
- Nephrology
- Orthopedics
- Epidemiology
Background:
- Current Kidney Disease Improving Global Outcomes guidelines suggest against bone mineral density (BMD) screening in chronic kidney disease (CKD) patients.
- This recommendation stems from a lack of association between BMD and fractures in prior cross-sectional studies of CKD patients.
Purpose of the Study:
- To investigate the association between BMD and incident fractures in older adults with and without CKD.
- To determine if BMD is a predictor of fracture risk across different CKD statuses.
Main Methods:
- Prospective cohort study (Health, Aging, and Body Composition) of well-functioning older individuals.
- Hip BMD measured by dual-energy x-ray absorptiometry; CKD defined as estimated GFR <60 ml/min/1.73 m².
- Cox proportional hazards analyses used to assess BMD's association with incident non-spine, fragility fractures over 11 years, adjusting for confounders and testing for interactions.
Main Results:
- Lower femoral neck BMD (FNBMD) was significantly associated with a higher risk of incident fractures in both individuals with and without CKD.
- Adjusted hazard ratios per lower SD FNBMD were 2.74 (95% CI, 1.99–3.77) for those with CKD and 2.15 (95% CI, 1.80–2.57) for those without CKD.
- Similar associations were observed for individuals with osteoporosis, irrespective of CKD status.
Conclusions:
- Bone mineral density is a valuable predictor of fracture risk in older individuals, including those with moderate chronic kidney disease.
- Findings suggest that BMD assessment may be beneficial for fracture risk stratification in older adults with CKD, contrary to current guidelines.
Background And Objectives:
Kidney Disease Improving Global Outcomes guidelines recommend against bone mineral density (BMD) screening in CKD patients with mineral bone disease, due to a lack of association of BMD with fractures in cross-sectional studies in CKD. We assessed whether BMD is associated with fractures in participants with and without CKD in the Health, Aging, and Body Composition study, a prospective study of well functioning older individuals.
Design, Setting, Participants, & Measurements:
Hip BMD was measured by dual-energy x-ray absorptiometry. Osteoporosis was defined as a femoral neck BMD (FNBMD) T score below -2.5 and CKD as an estimated GFR <60 ml/min per 1.73 m(2). The association of BMD with incident nonspine, fragility fractures to study year 11 was analyzed using Cox proportional hazards analyses, adjusting for age, race, sex, body mass index, hyperparathyroidism, low vitamin D level, and CKD. Interaction terms were used to assess whether the association of BMD with fracture differed in those with and without CKD.
Results:
There were 384 incident fractures in 2754 individuals (mean age 73.6 years). Lower FNBMD was associated with greater fracture, regardless of CKD status. After adjustment, the hazard ratios (95% confidence intervals) were 2.74 (1.99, 3.77) and 2.15 (1.80, 2.57) per lower SD FNBMD for those with and without CKD, respectively (interaction P=0.68), and 2.10 (1.23, 3.59) and 1.63 (1.18, 2.23) among those with osteoporosis in patients with and without CKD, respectively (interaction P=0.75).
Conclusions:
BMD provides information on risk for fracture in older individuals with or without moderate CKD.
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