Investigations of Chronic Kidney Disease Associations with Hip Fracture Incidence and Mortality in India.
Chronic Kidney Disease Associations with Hip Fracture
Background: Hip fracture is very common in patients with ESRD. The risk has been estimated to be 4.4 to 14 times greater than that of the general population. KD and hip fracture are important public health problems that share multiple risk factors. Both are more common in older individuals and patients with diabetes. In addition, CKD and low bone mineral density (BMD), a major risk factor for hip fracture, are highly coincident. Therefore, the study aim was to clarify the association of CKD with hip fracture incidence and mortality. Subjects and Methods: Present study included 700 participants which were divided into two groups according to kidney disease. Out of 700 subjects, 100 subjects with CKD were included in group I whereas, 600 subjects without CKD were included in group II. We chose femoral neck BMD as the main measurement of hip BMD in our analysis because this region is most predictive for hip fracture. We chose to use the Modification of Diet in Renal Disease (MDRD) formula to calculate the estimated GFR (eGFR). Results: It is interesting that when the demographic characteristics of the hip fracture populations were evaluated, there was an association among age, history of hip fracture, and prevalence of CKD. In the participants (aged 50 to 74), the prevalence of CKD was approximately three-fold higher in the group with a history of hip fracture than in the group without a hip fracture (12% versus 4%; P<0.01). However, in older participants (older than 75 yr), the prevalence of CKD was the same regardless of hip fracture history. Conclusion: By using different measures of hip fracture incidence and mortality, we have demonstrated why other studies have shown mixed associations between CKD and hip fracture. Hip fracture incidence was higher in individuals with CKD compared with those with normal eGFR particularly where measured with admissions. However, following a hip fracture, CKD did not increase post-hip fracture mortality except in those with CKD of various stages. Nonetheless, a reduction in hip fracture incidence in those with CKD would reduce the number of deaths after hip fracture in the Indian population.