Optimising bone health among older people with hip fractures and co-existing advanced chronic kidney disease
Terence Ong1,2, Boon Kang Aw Yong3, Tamara Shouter3
1Department for Healthcare of Older People, Queens Medical Centre, Nottingham University Hospitals NHS Trust, Derby Road, Nottingham, NG7 2UH, UK. terenceong@doctors.org.uk.
Insights
Elderly patients with hip fractures and advanced chronic kidney disease (CKD) have poor survival rates. Focus should shift to quality of life over bone health optimization in these high-risk individuals.
Area of Science:
- Nephrology
- Geriatrics
- Orthopedics
Background:
- Patients with hip fractures and advanced chronic kidney disease (CKD) face risks of secondary fractures from CKD-mineral bone disease or osteoporosis.
- CKD significantly complicates bone health management and patient outcomes.
Purpose of the Study:
- To analyze the outcomes of hip fracture patients with advanced CKD (stage 4-5).
- To understand the prevalence and impact of CKD on hip fracture patient survival and care.
Main Methods:
- Retrospective analysis of a hospital's hip fracture registry.
- Inclusion criteria: patients aged 60 years or older with CKD stage 4 or 5 over a 2-year period.
Main Results:
- 46 patients with advanced CKD (stage 4-5) were analyzed; prevalence was 3%.
- Mean age was 84 years; 76% had a high hip fracture risk score.
- Mortality was high: 54% at 12 months and 80% at 2 years. Osteoporosis treatment was absent at discharge; most received calcium/vitamin D, with poor clinic attendance.
Conclusions:
- Hip fracture patients with advanced CKD exhibit significantly poor survival.
- Care priorities for these patients may need to emphasize supportive living over aggressive bone health interventions.
Purpose:
Patients with a hip fracture and co-existing advanced chronic kidney disease (CKD) are at risk of further fractures due to either CKD-mineral bone disease or osteoporosis.
Methods:
An analysis of a hospital's hip fracture service registry of patients ≥ 60 years with CKD stage 4 (15-29 ml/min/1.73m2) or stage 5 (< 15 ml/min/1.73m2) over 2 years.
Results:
46 patients were included in the analysis. The prevalence of CKD stage 4 and 5 was 3%. The mean age was 84 years, half had ≥ 2 comorbid conditions and 76% had a Nottingham Hip Fracture Score of ≥ 5. 54% and 80% died at 12 months and 2 years. None were on any osteoporosis treatment on discharge. 85% were prescribed either calcium-vitamin D or vitamin D supplementation. 30% had a bone health clinic appointment made, but less than half attended.
Conclusion:
Patients with advanced CKD admitted to hospital with a hip fracture have a poor survival. In many, the focus of care should be on supporting quality daily living and not bone health optimisation.
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