Estimated GFR and fracture risk: a population-based study.

Area of Science:

• Nephrology
• Geriatrics
• Orthopedics

Background:

• Patients with end-stage renal disease (ESRD) exhibit elevated fracture risk.
• Conflicting evidence exists regarding fracture incidence in chronic kidney disease (CKD) patients.
• The association between estimated glomerular filtration rate (eGFR) and fracture rates requires clarification.

Purpose of the Study:

• To investigate the relationship between estimated glomerular filtration rate (eGFR) and fracture incidence in community-dwelling adults.
• To determine if reduced kidney function, independent of age and sex, increases the risk of hip, wrist, and vertebral fractures.

Main Methods:

• A large cohort of 1,815,943 adults with outpatient serum creatinine measurements (2002-2008) was analyzed.
• Exclusion criteria included eGFR <15 ml/min per 1.73 m(2) and dialysis requirement.
• Incident hip, wrist, and vertebral fractures were identified using diagnostic and procedure codes; Poisson regression analyzed adjusted fracture rates by eGFR, age, and sex.

Main Results:

• Over a median follow-up of 4.4 years, fracture rates increased with age across all sites.
• Unadjusted fracture rates rose with decreasing eGFR within age strata.
• However, adjusted analyses revealed similar fracture rates across eGFR categories, indicating no independent association between reduced eGFR and increased fracture risk.

Conclusions:

• Contrary to prior research, individuals with eGFR <60 ml/min per 1.73 m(2) do not demonstrate elevated rates of hip, wrist, or vertebral fractures.
• Age and sex appear to be more significant determinants of fracture risk than eGFR in this population.
• These findings suggest that CKD itself, independent of age and sex, may not be a primary driver of fracture incidence.