title: Bone Parameters and Risk of Hip and Femur Fractures in Patients on Hemodialysis.
abstract: Patients on hemodialysis have a high rate of hip fractures. In this study, we performed a contemporary analysis of mineral and bone parameters and their relationship to hip and femur fracture risk.
  
  
  
  Patients on hemodialysis treated between 2000 and 2013 in Fresenius Medical Care North America facilities were included. Predictors were on the basis of data as of December 31 of each baseline year and time-averaged values of selected laboratory parameters and medication doses throughout the year. Four period cohorts were constructed from baseline years: 2000, 2003, 2006, and 2009. Follow-up for each cohort was ≤3 years.
  
  
  
  The incidence of hip and femur fractures remained generally unchanged (P=0.40), except among patients who were white and >65 years of age, in whom the rate decreased significantly over the 14-year period (P<0.01). Results from combined multivariable models indicated that the lowest quartiles of time-averaged intact parathyroid hormone were independently associated with higher hip fracture risk (intact parathyroid hormone =181-272 pg/ml: hazard ratio, 1.20; 95% confidence interval [95% CI], 1.03 to 1.41 and intact parathyroid hormone <181 pg/ml: hazard ratio, 1.20; 95% CI, 1.01 to 1.44; referent third quartile, 273 to <433 pg/ml). The lowest quartile of time-averaged serum calcium was also associated with higher risk (calcium <8.7 mg/dl; hazard ratio, 1.17; 95% CI, 1.00 to 1.37) compared with the referent third quartile of 9.1 to <9.5 mg/dl.
  
  
  
  We found an association between lower levels of intact parathyroid hormone and serum calcium and greater risk for hip and femur fractures among patients on hemodialysis. These findings support additional research toward elucidating long-term safety of treatment approaches for hyperparathyroidism in patients with ESRD.
authors.affiliation: Department of Medicine, Division of Nephrology, Hofstra North Shore-Long Island Jewish School of Medicine, Great Neck, New York.
authors.forename: Steven
authors.initials: S
authors.lastname: Fishbane
authors.affiliation: Department of Medicine, Division of Nephrology, Hofstra North Shore-Long Island Jewish School of Medicine, Great Neck, New York.
authors.forename: Azzour D
authors.initials: AD
authors.lastname: Hazzan
authors.affiliation: Department of Medicine, Division of Nephrology, Hofstra North Shore-Long Island Jewish School of Medicine, Great Neck, New York.
authors.forename: Kenar D
authors.initials: KD
authors.lastname: Jhaveri
authors.affiliation: Fresenius Medical Care North America, Waltham, Massachusetts; and.
authors.forename: Lin
authors.initials: L
authors.lastname: Ma
authors.affiliation: Division of Nephrology, Tufts Medical Center and Tufts University School of Medicine, Boston, Massachusetts.
authors.forename: Eduardo
authors.initials: E
authors.lastname: Lacson
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002118:Calcium / Q000097:blood; D015331:Cohort Studies; D005260:Female; D005264:Femoral Fractures / Q000453:epidemiology*; D006620:Hip Fractures / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D007676:Kidney Failure, Chronic / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010281:Parathyroid Hormone / Q000097:blood*; D010758:Phosphorus / Q000097:blood; D006435:Renal Dialysis; D012307:Risk Factors; D014481:United States / Q000453:epidemiology; D044465:White People / Q000706:statistics & numerical data
chemical_list: D010281:Parathyroid Hormone; D010758:Phosphorus; D002118:Calcium
keywords: Bone and Bones; Follow-Up Studies; Hip Fractures; Humans; Incidence; Kidney Failure, Chronic; calcium; hemodialysis; hyperparathyroidism; parathyroid hormone