title: Dementia is a major risk factor for hip fractures in patients with chronic kidney disease.
abstract: Chronic kidney disease increases the risk of hip fractures which can be promoted by dementia. We here showed that dementia increased the risk of hip fractures in dialysis patients, but in a similar manner than without dialysis. Attention should be paid to dementia to prevent hip fractures.
  
  
  BACKGROUND
  Hip fractures (HF) are associated with significant morbidity and is further increased in patients with chronic kidney disease (CKD). Dementia, frequent in CKD, might be a risk factor for HF. We here aimed to assess if dementia increased the risk of hip fracture in CKD.
  
  
  METHODS
  The study was derived from the French National Database of Hospitalization. Data were obtained over the period 2011-2013. Three populations of subjects >60 years were extracted. Hip fractures, dialysis, and dementia were the main studied factors. The three populations were crossed to estimate the fracture risk based on dementia or dialysis, adjusted for age and gender. The fracture risk was calculated using a multiple logistic regression model.
  
  
  RESULTS
  Over this period, 213,180 patients experienced a HF, 660,434 patients were diagnosed for dementia, and 47,430 patients were on dialysis. There was an effect of age and gender on the incidence of HF and dementia. In CKD patients, the risk of HF was significantly higher in demented patients compared to those without dementia: OR 2.0 [95 % CI 1.7-2.4], this being the same for men (OR 2.4 [1.8-3.1]) and women (OR 2.6 [2.0-3.3]) and at any age. However, the adjusted risk for HF in demented patients on dialysis therapy is not different than in demented patients without CKD (OR 1.3 [1.0-1.6]).
  
  
  CONCLUSIONS
  Dementia significantly increases the risk of HF in patients on dialysis, but this risk in demented patients is equally high whether receiving dialysis therapy or not. These results highlight dementia as a major risk factor for HF in dialysis and indicate that reduction of fracture risk should include dementia as a risk factor.
authors.affiliation: Department of Rheumatology, Lariboisière Hospital, Paris, France.
authors.forename: M
authors.initials: M
authors.lastname: Maravic
authors.affiliation: Inserm U1132 and University Paris-Diderot, Department of Rheumatology, Lariboisière Hospital, 2 rue Ambroise Paré, 75010, Paris, France.
authors.forename: A
authors.initials: A
authors.lastname: Ostertag
authors.affiliation: Department of Dialysis, Clinique du Landy, Saint-Ouen, France.|Department of Renal Physiology, Necker Hospital, University of Paris Descartes, Paris, France.
authors.forename: P
authors.initials: P
authors.lastname: Urena
authors.affiliation: Inserm U1132 and University Paris-Diderot, Department of Rheumatology, Lariboisière Hospital, 2 rue Ambroise Paré, 75010, Paris, France. martine.cohen-solal@inserm.fr.
authors.forename: M
authors.initials: M
authors.lastname: Cohen-Solal
mesh_terms: D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D016208:Databases, Factual; D003704:Dementia / Q000150:complications* / Q000453:epidemiology; D005260:Female; D005602:France / Q000453:epidemiology; D006620:Hip Fractures / Q000453:epidemiology / Q000209:etiology*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000453:epidemiology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D058866:Osteoporotic Fractures / Q000453:epidemiology / Q000209:etiology*; D015995:Prevalence; D006435:Renal Dialysis; D012307:Risk Factors; D017678:Sex Distribution
keywords: Bone; Dementia; Dialysis; Fracture