title: Increasing hip fractures in patients receiving hemodialysis and peritoneal dialysis.
abstract: OBJECTIVE
  Dialysis patients are at increased risk for hip fractures. Because changes in treatment of metabolic bone disease in this population may have impacted bone fragility, this study aims to analyze the longitudinal risk for fractures in hemodialysis (HD) and peritoneal dialysis (PD) patients.
  
  
  METHODS
  Using the United States Renal Data System database from 1992 to 2009, the temporal trend in hip fractures requiring hospitalization was analyzed using an overdispersed Poisson regression model. Generalized Estimating Equations were used to assess the adjusted effect of dialysis modality on hip fractures.
  
  
  RESULTS
  842,028 HD and 87,086 PD patients were included. There was a significant temporal increase in hip fractures in both HD and PD with stabilization of rates after 2005. With stratification, the increase in fractures occurred in patients who were white and over 65 years of age. In adjusted analyses, HD patients had 1.6 times greater odds of hip fracture than PD patients (OR 1.60 95% CI 1.52, 1.68, p < 0.001).
  
  
  CONCLUSIONS
  In contrast to the declining hip fracture rates in the general population, we identified a temporal rise in incidence of hip fractures in HD and PD patients. HD patients were at a higher risk for hip fractures than PD patients after adjustment for recognized bone fragility risk factors. The increase in fracture rate over time was limited to older white patients in both HD and PD, the demographics being consistent with osteoporosis risk. Further research is indicated to better understand the longitudinal trend in hip fractures and the discordance between HD and PD.
authors.affiliation: Hofstra NSLIJ School of Medicine, North Shore University Hospital and Long Island Jewish Medical Center, Great Neck, N.Y., USA.
authors.forename: Anna T
authors.initials: AT
authors.lastname: Mathew
authors.forename: Azzour
authors.initials: A
authors.lastname: Hazzan
authors.forename: Kenar D
authors.initials: KD
authors.lastname: Jhaveri
authors.forename: Geoffrey A
authors.initials: GA
authors.lastname: Block
authors.forename: Shailaja
authors.initials: S
authors.lastname: Chidella
authors.forename: Lisa
authors.initials: L
authors.lastname: Rosen
authors.forename: John
authors.initials: J
authors.lastname: Wagner
authors.forename: Steve
authors.initials: S
authors.lastname: Fishbane
mesh_terms: D000293:Adolescent; D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001213:Asian / Q000706:statistics & numerical data; D016208:Databases, Factual; D005006:Ethnicity / Q000706:statistics & numerical data*; D005260:Female; D006620:Hip Fractures / Q000453:epidemiology* / Q000208:ethnology; D006801:Humans; D015994:Incidence; D007198:Indians, North American / Q000706:statistics & numerical data; D007676:Kidney Failure, Chronic / Q000628:therapy*; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D010530:Peritoneal Dialysis / Q000706:statistics & numerical data*; D012044:Regression Analysis; D006435:Renal Dialysis / Q000706:statistics & numerical data; D012307:Risk Factors; D014481:United States / Q000453:epidemiology; D044465:White People / Q000706:statistics & numerical data; D055815:Young Adult