title: The three-year incidence of fracture in chronic kidney disease.
abstract: Knowing a person's fracture risk according to their kidney function, gender, and age may influence clinical management and decision-making. Using healthcare databases from Ontario, Canada, we conducted a cohort study of 679,114 adults of 40 years and over (mean age 62 years) stratified at cohort entry by estimated glomerular filtration rate ((eGFR) 60 and over, 45-59, 30-44, 15-29, and under 15 ml/min per 1.73 m(2)), gender, and age (40-65 and over 65 years). The primary outcome was the 3-year cumulative incidence of fracture (proportion of adults who fractured (hip, forearm, pelvis, or proximal humerus) at least once within 3-years of follow-up). Additional analyses examined the fracture incidence per 1000 person-years, hip fracture alone, stratification by prior fracture, stratification by eGFR and proteinuria, and 3-year cumulative incidence of falls with hospitalization. The 3-year cumulative incidence of fracture significantly increased in a graded manner in adults with a lower eGFR for both genders and both age groups. The 3-year cumulative incidence of fracture in women over 65 years of age across the 5 eGFR groups were 4.3%, 5.8%, 6.5%, 7.8%, and 9.6%, respectively. Corresponding estimates for men over 65 years were 1.6%, 2.0%, 2.7%, 3.8%, and 5.0%, respectively. Similar graded relationships were found for falls with hospitalization and additional analyses. Thus, many adults with chronic kidney disease will fall and fracture. Results can be used for prognostication and guidance of sample size requirements for fracture prevention trials.
authors.affiliation: 1] Division of Nephrology, Western University, London, Ontario, Canada [2] Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada.
authors.forename: Kyla L
authors.initials: KL
authors.lastname: Naylor
authors.affiliation: Institute for Clinical Evaluative Sciences (ICES), London, Ontario, Canada.
authors.forename: Eric
authors.initials: E
authors.lastname: McArthur
authors.affiliation: Department of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.
authors.forename: William D
authors.initials: WD
authors.lastname: Leslie
authors.affiliation: Division of Endocrinology, Western University, London, Ontario, Canada.
authors.forename: Lisa-Ann
authors.initials: LA
authors.lastname: Fraser
authors.affiliation: Women's College Hospital, Toronto, Ontario, Canada.
authors.forename: Sophie A
authors.initials: SA
authors.lastname: Jamal
authors.affiliation: 1] Institute for Clinical Evaluative Sciences (ICES), London, Ontario, Canada [2] Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Suzanne M
authors.initials: SM
authors.lastname: Cadarette
authors.affiliation: Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Jennie G
authors.initials: JG
authors.lastname: Pouget
authors.affiliation: Division of Medicine, Toronto General Hospital, Toronto, Ontario, Canada.
authors.forename: Charmaine E
authors.initials: CE
authors.lastname: Lok
authors.affiliation: Division of Nephrology, Western University, London, Ontario, Canada.
authors.forename: Anthony B
authors.initials: AB
authors.lastname: Hodsman
authors.affiliation: Division of Rheumatology, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Jonathan D
authors.initials: JD
authors.lastname: Adachi
authors.affiliation: 1] Division of Nephrology, Western University, London, Ontario, Canada [2] Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada [3] Institute for Clinical Evaluative Sciences (ICES), London, Ontario, Canada.
authors.forename: Amit X
authors.initials: AX
authors.lastname: Garg
mesh_terms: D000058:Accidental Falls / Q000706:statistics & numerical data; D000328:Adult; D000367:Age Factors; D000368:Aged; D015331:Cohort Studies; D005260:Female; D050723:Fractures, Bone / Q000453:epidemiology*; D005919:Glomerular Filtration Rate; D006620:Hip Fractures / Q000453:epidemiology; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009864:Ontario / Q000453:epidemiology; D010384:Pelvic Bones / Q000293:injuries*; D011507:Proteinuria / Q000453:epidemiology; D011885:Radius Fractures / Q000453:epidemiology; D051437:Renal Insufficiency / Q000453:epidemiology* / Q000503:physiopathology*; D012737:Sex Factors; D012784:Shoulder Fractures / Q000453:epidemiology; D014458:Ulna Fractures / Q000453:epidemiology