title: Moderate chronic kidney disease in women is associated with fracture occurrence independently of osteoporosis.
abstract: BACKGROUND
  Chronic kidney disease (CKD) is associated with increased risk of fragility fracture but whether this is independent of osteoporosis is unclear.
  
  
  METHODS
  We conducted a retrospective cross-sectional study of 1,702 female patients referred for dual-energy X-ray absorptiometry (DXA) scanning (Lunar IDXA) between September 2006 and April 2007. Estimated glomerular filtration rate (eGFR; ml/min/1.73 m(2)) by Modification of Diet in Renal Disease was calculated within 1 year (median interval 4 weeks) of the DXA scan. The independent association of self-reported fracture occurrence with eGFR category was assessed using multivariate logistic regression.
  
  
  RESULTS
  Mean age (SD) was 61.7 (10.8) years; mean eGFR (SD) was 68.8 (12.2). The percentages of subjects with an eGFR of 75-89, 60-74, 30-59 and <30 was 34, 45, 20 and 0.8%, respectively. Forty-seven percent had osteoporosis. Mean T scores for the above eGFR categories were -2.2, -2.3, -2.5 and -3.0, respectively (p trend <0.001). Osteoporosis was significantly associated with eGFR on univariate analysis but not following adjustment for age. The percentage of patients with a fracture (29%) and with multiple prior fractures (3.5%) was higher at lower eGFR (p < 0.001, χ(2) test). The adjusted odds ratios (95% confidence interval) of any prior fracture for eGFR 75-89, 60-74 and 30-59 were 1.0 (reference), 1.2 (0.9-1.6) and 1.4 (1.0-1.9), respectively, adjusting simultaneously for age, T score, risk factors and treatment for osteoporosis.
  
  
  CONCLUSIONS
  Moderate CKD is a significant independent predictor of fracture occurrence.
authors.affiliation: Department of Nephrology, Cork University Hospital, Cork, Ireland.
authors.forename: Sinead
authors.initials: S
authors.lastname: Kinsella
authors.forename: Shawn
authors.initials: S
authors.lastname: Chavrimootoo
authors.forename: Michael G
authors.initials: MG
authors.lastname: Molloy
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Eustace
mesh_terms: D015502:Absorptiometry, Photon; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015519:Bone Density; D002908:Chronic Disease; D003430:Cross-Sectional Studies; D005260:Female; D050723:Fractures, Bone / Q000453:epidemiology* / Q000209:etiology; D005598:Fractures, Spontaneous / Q000453:epidemiology* / Q000209:etiology; D005919:Glomerular Filtration Rate; D006801:Humans; D007494:Ireland / Q000453:epidemiology; D007674:Kidney Diseases / Q000453:epidemiology* / Q000378:metabolism; D008875:Middle Aged; D008903:Minerals / Q000378:metabolism; D010024:Osteoporosis / Q000000981:diagnostic imaging / Q000453:epidemiology*; D012189:Retrospective Studies; D012306:Risk; D055815:Young Adult
chemical_list: D008903:Minerals