Fracture Risk Assessment in Chronic Kidney Disease, Prospective Testing Under Real World Environments (FRACTURE): a prospective study.
BACKGROUND
Chronic kidney disease (CKD) is associated with an increased risk of fracture. Decreased bone mass and disruption of microarchitecture occur early in the course of CKD and worsens with the progressive decline in renal function so that at the time of initiation of dialysis at least 50% of patients have had a fracture. Despite the excess fracture risk, and the associated increases in morbidity and mortality, little is known about the factors that are associated with an increase in fracture risk. Our study aims to identify prognostic factors for bone loss and fractures in patients with stages 3 to 5 CKD.


METHODS
This prospective study aims to enroll two hundred and sixty men and women with stages 3 to 5 CKD. Subjects will be followed for 24 months and we will examine the ability of: 1) bone mineral density by dual x-ray absorptiometry at the spine, hip, and radius; 2) volumetric bone density by high resolution peripheral quantitated computed tomography at the radius and tibia; 3) serum markers of bone turnover; 4) bone formation rate by bone biopsy; and 5) muscle strength and balance to predict spine and non-spine fractures, identified by self-report and/or vertebral morphometry. All measurements will be obtained at baseline, at 12 and at 24 months with the exception of bone biopsy, which will be measured once at 12 months. Subjects will be contacted every 4 months to determine if there have been incident fractures or falls.


CONCLUSIONS
This study is one of the first that aims to identify risk factors for fracture in early stage CKD patients. Ultimately, by identifying risk factors for fracture and targeting treatments in this group-before the initiation of renal replacement therapy--we will reduce the burden of disease due to fractures among patients with CKD.
West
Sarah L
SL
Multidisciplinary Osteoporosis Program, Women's College Hospital, and Department of Exercise Sciences, University of Toronto, Toronto, Ontario, Canada. sarah.west@utoronto.ca
Lok
Charmaine E
CE
Jamal
Sophie A
SA
D015502:Absorptiometry, Photon; D000058:Accidental Falls / Q000706:statistics & numerical data; D000328:Adult; D000368:Aged; D001706:Biopsy; D015519:Bone Density; D001851:Bone Diseases, Metabolic / Q000150:complications; D001842:Bone and Bones / Q000737:chemistry / Q000000981:diagnostic imaging / Q000473:pathology; D002908:Chronic Disease; D012080:Chronic Kidney Disease-Mineral and Bone Disorder / Q000150:complications; D002986:Clinical Trials as Topic / Q000379:methods*; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D050723:Fractures, Bone / Q000453:epidemiology* / Q000209:etiology; D006801:Humans; D007674:Kidney Diseases / Q000150:complications*; D008297:Male; D008875:Middle Aged; D015337:Multicenter Studies as Topic / Q000379:methods*; D053580:Muscle Strength; D009864:Ontario / Q000453:epidemiology; D011446:Prospective Studies; D012107:Research Design; D018570:Risk Assessment; D016103:Spinal Fractures / Q000453:epidemiology / Q000209:etiology; D014057:Tomography, X-Ray Computed; D055815:Young Adult