Renal function and risk of hip and vertebral fractures in older women.
BACKGROUND
An increased rate of hip fractures has been reported in patients with end-stage renal disease, but the effect of less severe renal dysfunction on fracture risk is uncertain.


METHODS
We conducted a case-cohort study within a cohort of 9704 women 65 years or older to compare baseline renal function (estimated glomerular filtration rate [eGFR] using the Cockcroft-Gault equation) in 149 women who subsequently had hip fractures and 150 women who subsequently had vertebral fractures with eGRF in 396 randomly selected women.


RESULTS
In models adjusted for age, weight, and calcaneal bone density, decreasing eGFR was associated with increased risk of hip fracture. Compared with women with an eGFR 60 mL/min per 1.73 m(2) or greater, the hazard ratio (95% confidence interval [CI]) for hip fracture was 1.57 (95% CI, 0.89-2.76) in those with an eGFR 45 to 59 mL/min per 1.73 m(2) and 2.32 (95% CI, 1.15-4.68) in those with an eGFR less than 45 mL/min per 1.73 m(2) (P for trend = .02). In particular, women with a reduced eGFR were at increased risk of trochanteric hip fracture (adjusted hazard ratio, 3.93 [95% CI, 1.37-11.30] in women with an eGFR 45-59 mL/min per 1.73 m(2) and 7.17 [95% CI, 1.93-26.67] in women with an eGFR <45 mL/min per 1.73 m(2); P for trend = .004). Renal function was not independently associated with risk of vertebral fracture (adjusted odds ratio, 1.08 [95% CI, 0.61-1.92] in women with an eGFR 45-59 mL/min per 1.73 m(2) and 1.33 [95% CI, 0.63-2.80] in women with an eGFR <45 mL/min per 1.73 m(2); P for trend = .47).


CONCLUSIONS
Older women with moderate renal dysfunction are at increased risk of hip fracture.
Ensrud
Kristine E
KE
Center for Chronic Disease Outcomes Research, VA Medical Center, Minneapolis, MN 55417, USA. ensru001@umn.edu
Lui
Li-Ying
LY
Taylor
Brent C
BC
Ishani
Areef
A
Shlipak
Michael G
MG
Stone
Katie L
KL
Cauley
Jane A
JA
Jamal
Sophie A
SA
Antoniucci
Diana M
DM
Cummings
Steven R
SR
D000368:Aged; D001835:Body Weight; D015519:Bone Density; D002908:Chronic Disease; D015331:Cohort Studies; D005260:Female; D005919:Glomerular Filtration Rate; D006620:Hip Fractures / Q000453:epidemiology* / Q000209:etiology; D006801:Humans; D007674:Kidney Diseases / Q000150:complications* / Q000503:physiopathology; D016015:Logistic Models; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D018570:Risk Assessment; D016103:Spinal Fractures / Q000453:epidemiology* / Q000209:etiology