title: Fracture Incidence in Adult Kidney Transplant Recipients.
abstract: BACKGROUND
  It remains uncertain whether kidney transplant recipients are a high-risk group for fracture.
  
  
  METHODS
  We conducted a cohort study using Ontario, Canada health care databases to estimate the 3-, 5- and 10-year cumulative incidence of nonvertebral fracture (proximal humerus, forearm, hip) in adult kidney transplant recipients between 1994 and 2009, stratifying by sex and age (<50 versus ≥50 years) at transplant. We also assessed the 3-year cumulative incidence of all fracture locations (excluding skull, toes, and fingers) and falls, 10-year cumulative incidence of hip fracture alone, and nonvertebral fracture incidence in recipients compared to nontransplant reference groups matched on age, sex, and cohort entry year. We studied 4821 recipients (median age, 50 years).
  
  
  RESULTS
  Among the age and sex strata, female recipients aged 50 years or older had the highest 3-year cumulative incidence of nonvertebral fracture (3.1%; 95% confidence interval [95% CI], 2.1-4.4%). Recipients had a higher 3-year cumulative incidence of nonvertebral fracture (1.6%; 95% CI, 1.3-2.0%) compared to the general population with no previous nonvertebral fracture (0.5%; 95% CI, 0.4-0.6%; P < 0.0001) and nondialysis chronic kidney disease (1.1%; 95% CI, 0.9-1.2%; P = 0.03), but a lower fracture incidence than the general population with a previous nonvertebral fracture (2.3%; 95% CI, 1.9-2.8%; P = 0.007). The 10-year cumulative incidence of hip fracture in all recipients was 1.7% (≥3% defined as high risk in clinical guidelines).
  
  
  CONCLUSIONS
  Kidney transplant recipients may have a lower fracture risk than previously suggested in the literature. Results inform our understanding of fracture incidence after kidney transplantation and how it compares to nontransplant populations.
authors.affiliation: 1 Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada. 2 Division of Nephrology, Western University, London, Ontario, Canada. 3 Women's College Hospital, Toronto, Ontario, Canada. 4 Institute for Clinical Evaluative Sciences (ICES), Ontario, Canada. 5 Department of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada. 6 Division of Nephrology, University Health Network, University of Toronto, Toronto, Ontario, Canada. 7 Division of Nephrology, Kidney Research Centre, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada. 8 Division of Endocrinology, Western University, London, Ontario, Canada. 9 Division of Rheumatology, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Kyla L
authors.initials: KL
authors.lastname: Naylor
authors.forename: Sophie A
authors.initials: SA
authors.lastname: Jamal
authors.forename: Guangyong
authors.initials: G
authors.lastname: Zou
authors.forename: Eric
authors.initials: E
authors.lastname: McArthur
authors.forename: Ngan N
authors.initials: NN
authors.lastname: Lam
authors.forename: William D
authors.initials: WD
authors.lastname: Leslie
authors.forename: Anthony B
authors.initials: AB
authors.lastname: Hodsman
authors.forename: S Joseph
authors.initials: SJ
authors.lastname: Kim
authors.forename: Gregory A
authors.initials: GA
authors.lastname: Knoll
authors.forename: Lisa-Ann
authors.initials: LA
authors.lastname: Fraser
authors.forename: Jonathan D
authors.initials: JD
authors.lastname: Adachi
authors.forename: Amit X
authors.initials: AX
authors.lastname: Garg
mesh_terms: D000328:Adult; D000367:Age Factors; D016208:Databases, Factual; D005260:Female; D005543:Forearm Injuries / Q000175:diagnosis / Q000453:epidemiology; D050723:Fractures, Bone / Q000175:diagnosis / Q000453:epidemiology*; D006620:Hip Fractures / Q000175:diagnosis / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D009864:Ontario / Q000453:epidemiology; D018570:Risk Assessment; D012307:Risk Factors; D012737:Sex Factors; D012784:Shoulder Fractures / Q000175:diagnosis / Q000453:epidemiology; D013997:Time Factors; D066027:Transplant Recipients / Q000706:statistics & numerical data*; D016896:Treatment Outcome