title: Fracture risk in living kidney donors: a matched cohort study.
abstract: BACKGROUND
  Chronic kidney disease increases the risk of bone fragility fractures (osteoporotic fractures). Living kidney donors lose 50% of their renal mass and show changes in calcium homeostasis. We studied whether living kidney donation increases the risk of fragility fracture.
  
  
  METHODS
  Retrospective matched-cohort study.
  
  
  METHODS
  We reviewed the medical charts of all 2,015 adults in Ontario, Canada, who donated a kidney between 1992 and 2009 (surgeries performed across 5 transplant programs). We linked this information to health care databases and randomly selected 20,150 matched nondonors from the healthiest portion of the general population. Median age was 43 (95% CI, 24-50) years at study enrollment. Donors and nondonors were then followed up for a median of 6.6 years and a maximum of 17.7 years.
  
  
  METHODS
  Living donor nephrectomy.
  
  
  RESULTS
  The primary outcome was lower- and upper-extremity fragility fractures. Individuals who reached 66 years or older in follow-up had bisphosphonate prescriptions recorded.
  
  
  RESULTS
  The rate of fragility fracture was no higher in donors compared with nondonors (16.4 vs 18.7 events/10,000 person-years; rate ratio, 0.88; 95% CI, 0.58-1.32). Results were similar in multiple additional analyses. There was little difference in the proportion of older adults in follow-up who received a bisphosphonate prescription (17.1% vs 15.2%; P = 0.4).
  
  
  CONCLUSIONS
  These are interim results. Ongoing surveillance of this and other donor cohorts is warranted to be sure an association does not manifest with longer follow-up.
  
  
  CONCLUSIONS
  To date, there is no evidence of increased fragility fracture risk in living kidney donors. Our results meet an information need and are reassuring for the safety of the practice.
authors.affiliation: Division of Nephrology, Department of Medicine, Western University, London, Canada. amit.garg@lhsc.on.ca
authors.forename: Amit X
authors.initials: AX
authors.lastname: Garg
authors.forename: Jennie
authors.initials: J
authors.lastname: Pouget
authors.forename: Ann
authors.initials: A
authors.lastname: Young
authors.forename: Anjie
authors.initials: A
authors.lastname: Huang
authors.forename: Neil
authors.initials: N
authors.lastname: Boudville
authors.forename: Anthony
authors.initials: A
authors.lastname: Hodsman
authors.forename: Jonathan D
authors.initials: JD
authors.lastname: Adachi
authors.forename: William D
authors.initials: WD
authors.lastname: Leslie
authors.forename: Suzanne M
authors.initials: SM
authors.lastname: Cadarette
authors.forename: Charmaine E
authors.initials: CE
authors.lastname: Lok
authors.forename: Mauricio
authors.initials: M
authors.lastname: Monroy-Cuadros
authors.forename: G V Ramesh
authors.initials: GV
authors.lastname: Prasad
authors.forename: Sonia M
authors.initials: SM
authors.lastname: Thomas
authors.forename: Kyla
authors.initials: K
authors.lastname: Naylor
authors.forename: Darin
authors.initials: D
authors.lastname: Treleavan
mesh_terms: D000328:Adult; D017677:Age Distribution; D016022:Case-Control Studies; D016001:Confidence Intervals; D016208:Databases, Factual; D005260:Female; D005500:Follow-Up Studies; D005598:Fractures, Spontaneous / Q000453:epidemiology* / Q000209:etiology* / Q000503:physiopathology; D006801:Humans; D015994:Incidence; D016030:Kidney Transplantation / Q000379:methods*; D019520:Living Donors; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000009:adverse effects* / Q000379:methods; D009864:Ontario / Q000453:epidemiology; D016012:Poisson Distribution; D016016:Proportional Hazards Models; D012016:Reference Values; D012189:Retrospective Studies; D018570:Risk Assessment; D017678:Sex Distribution; D013997:Time Factors