title: Temporal trends in the incidence, treatment, and outcomes of hip fracture in older patients initiating dialysis in the United States.
abstract: OBJECTIVE
  Patients with ESRD experience a fivefold higher incidence of hip fracture than the age- and sex-matched general population. Despite multiple changes in the treatment of CKD mineral bone disorder, little is known about long-term trends in hip fracture incidence, treatment patterns, and outcomes in patients on dialysis.
  
  
  METHODS
  Fourteen annual cohorts (1996-2009) of older patients (≥67 years) initiating dialysis in the United States were studied. Eligible patients had Medicare fee-for-service coverage for ≥2 years before dialysis initiation and were followed for ≤3 years for a first hip fracture. Type of treatment (internal fixation or partial or total hip replacement) was ascertained along with 30-day mortality. Cox and modified Poisson regressions were used to describe trends in study outcomes.
  
  
  RESULTS
  This study followed 409,040 patients over 607,059 person-years, during which time 17,887 hip fracture events were recorded (29.3 events/1000 person-years). Compared with patients incident for ESRD in 1996, adjusted hip fracture rates increased until the 2004 cohort (+41%) and declined thereafter. Surgical treatment included internal fixation in 56%, partial hip replacement in 29%, and total hip replacement in 2%, which remained essentially unchanged over time; 30-day mortality after hip fracture declined from 20% (1996) to 16% (2009).
  
  
  CONCLUSIONS
  Hip fracture incidence rates remain higher today than in patients reaching ESRD in 1996, despite multiple purported improvements in the management of CKD mineral bone disorder. Although recent declines in incidence and steady declines in associated short-term mortality are encouraging, hip fractures remain among the most common and consequential noncardiovascular complications of ESRD.
authors: Division of Nephrology, Division of General Medical Disciplines, Stanford University School of Medicine, Palo Alto, CA 94304, USA.
authors: Sumi Sukumaran
authors: SS
authors: Nair
authors: Aya A
authors: AA
authors: Mitani
authors: Benjamin A
authors: BA
authors: Goldstein
authors: Glenn M
authors: GM
authors: Chertow
authors: David W
authors: DW
authors: Lowenberg
authors: Wolfgang C
authors: WC
authors: Winkelmayer
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006620:Hip Fractures / Q000453:epidemiology* / Q000628:therapy; D006801:Humans; D015994:Incidence; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000628:therapy; D008297:Male; D016016:Proportional Hazards Models; D006435:Renal Dialysis; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology
references: Int Orthop. 2003;27(1):11-7
references: 12582802
references: JAMA. 2009 Oct 14;302(14):1573-9
references: 19826027
references: Am J Kidney Dis. 2000 Dec;36(6):1115-21
references: 11096034
references: J Bone Miner Res. 2012 Nov;27(11):2325-32
references: 22692958
references: Arch Intern Med. 2011 Aug 8;171(15):1371-8
references: 21824952
references: Kidney Int. 2000 Jul;58(1):396-9
references: 10886587
references: Am J Kidney Dis. 2012 Jan;59(1 Suppl 1):A7, e1-420
references: 22177944
references: Kidney Int. 2000 Nov;58(5):2200-5
references: 11044242
references: J Am Geriatr Soc. 2003 Mar;51(3):364-70
references: 12588580
references: J Ren Care. 2009 Mar;35 Suppl 1:7-13
references: 19222725
references: JAMA. 2002 Dec 18;288(23):3014-8
references: 12479766
references: J Bone Miner Res. 2007 Mar;22(3):465-75
references: 17144789
references: Am J Kidney Dis. 2011 Apr;57(4):602-11
references: 21186072
references: Kidney Int. 2006 Oct;70(7):1358-66
references: 16929251
references: Epidemiology. 1994 Sep;5(5):541-4
references: 7986870
references: J Clin Epidemiol. 1992 Jul;45(7):703-14
references: 1619449
references: Am J Epidemiol. 2010 Aug 1;172(3):327-33
references: 20573839