title: Temporal trends in fracture rates and postdischarge outcomes among hemodialysis patients.
abstract: Patients with ESRD have a substantially increased risk of bone fractures, but the burden of fractures has not been sufficiently characterized in this population. Here, we analyzed fracture rates and postdischarge outcomes using Medicare data from hemodialysis patients in the United States between 2000 and 2009. We assessed adjusted quarterly fracture rates (inpatient and outpatient) and consequences of postfracture hospitalization for seven categories of fracture location. Pelvis/hip, vertebral, and lower leg fractures were the most prevalent fracture types. Pelvis/hip fractures declined slightly from 29.6 to 20.6 per 1000 patient-years between early 2000 and late 2009, but the incidence rates for all other fracture types remained relatively constant. Median lengths of stay for the primary fracture hospitalization ranged from 5 days (interquartile range [IQR], 3-9 days) for forearm/wrist fractures to 8 days (IQR, 5-12 days) for femur fractures. The proportion of patients discharged from the primary hospitalization to a skilled-nursing facility ranged from 28% (ribs/sternum) to 47% (pelvis/hip). A negative binomial regression model suggested that patients had an adjusted mean of 3.8-5.2 additional hospitalizations during the year after discharge from the index hospitalization, varying by fracture type, comprising a mean of 33-52 inpatient days. Case-mix-adjusted mortality rates after discharge ranged from 0.43 to 0.91 per patient-year and were highest for vertebral, pelvis/hip, and femur fractures. In conclusion, fractures in the dialysis population are common and are associated with a substantially increased risk for death and hospitalization.
authors.affiliation: Division of Pharmaceutical Outcomes and Policy, Eshelman School of Pharmacy, University of North Carolina Chapel Hill, USA.
authors.forename: Anne C
authors.initials: AC
authors.lastname: Beaubrun
authors.forename: Ryan D
authors.initials: RD
authors.lastname: Kilpatrick
authors.forename: Janet K
authors.initials: JK
authors.lastname: Freburger
authors.forename: Brian D
authors.initials: BD
authors.lastname: Bradbury
authors.forename: Lily
authors.initials: L
authors.lastname: Wang
authors.forename: M Alan
authors.initials: MA
authors.lastname: Brookhart
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D050723:Fractures, Bone / Q000453:epidemiology* / Q000401:mortality / Q000628:therapy*; D006620:Hip Fractures / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D007676:Kidney Failure, Chronic / Q000401:mortality / Q000628:therapy*; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D006278:Medicare / Q000706:statistics & numerical data* / Q000639:trends*; D008875:Middle Aged; D010351:Patient Discharge; D006435:Renal Dialysis; D012189:Retrospective Studies; D012307:Risk Factors; D016103:Spinal Fractures / Q000453:epidemiology; D015996:Survival Rate; D013978:Tibial Fractures / Q000453:epidemiology; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D055815:Young Adult