title: Symptomatic fracture risk in the renal replacement therapy population.
abstract: BACKGROUND
  Bone fractures are an important cause of morbidity and mortality in patients on renal replacement therapy (RRT). The aim of this multicentre observational study was to quantify the incidence of radiologically proven bone fracture by anatomical site in prevalent RRT groups and study its relationship to potential risk factors.
  
  
  METHODS
  We performed a retrospective analysis of electronic records of all 2096 adults prevalent on RRT in the West of Scotland on 7 July 2010 across all hospitals (except one where inception was 1 August 2011) to identify all subsequent radiologically proven fractures during a median 3-year follow-up.
  
  
  RESULTS
  There were 340 fractures, with an incidence of 62.8 per 1000 patient-years. The incidences were 37.6, 99.2 and 57.6 per 1000 patient-years in the transplant, haemodialysis (HD) and peritoneal dialysis (PD) groups, respectively (P < 0.05). In the multivariable model, age and HD (relative to transplant or PD) were independently associated with increased risk of fractures, while primary glomerular disease, increasing serum albumin and taking alfacalcidol or lanthanum were associated with decreased risk. In a multivariable model of only HD patients, age was independently associated with an increased risk of fractures, while glomerular disease, high serum albumin and being on alfacalcidol and lanthanum were associated with decreased risk. In a multivariable model in transplant patients, there were no significant independent predictors of fracture.
  
  
  CONCLUSIONS
  The risk of symptomatic bone fracture is high in RRT patients and is ∼2.5 times higher in HD than in renal transplant patients, with the increased risk being independent of baseline factors. Fracture risk increases with age and lower serum albumin and is reduced if the primary renal diagnosis is glomerular disease. The possible protective role of alfacalcidol and lanthanum in HD patients deserves further exploration.
authors.affiliation: Renal Unit, University Hospital Crosshouse, Kilmarnock, UK.
authors.forename: Vishal
authors.initials: V
authors.lastname: Dey
authors.affiliation: Glasgow Renal and Transplant Unit, Glasgow, UK.
authors.forename: Tariq E
authors.initials: TE
authors.lastname: Farrah
authors.affiliation: Renal Unit, Monklands Hospital, Glasgow, UK.
authors.forename: Jamie P
authors.initials: JP
authors.lastname: Traynor
authors.affiliation: Renal Unit, University Hospital Crosshouse, Kilmarnock, UK.
authors.forename: Elaine M
authors.initials: EM
authors.lastname: Spalding
authors.affiliation: Renal Unit, Dumfries and Galloway Royal Infirmary, Dumfries, UK.
authors.forename: Susan E
authors.initials: SE
authors.lastname: Robertson
authors.affiliation: Glasgow Renal and Transplant Unit, Glasgow, UK.
authors.forename: Colin C
authors.initials: CC
authors.lastname: Geddes
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D050071:Bone Density Conservation Agents / Q000627:therapeutic use; D005260:Female; D050723:Fractures, Bone / Q000188:drug therapy / Q000453:epidemiology / Q000209:etiology*; D006801:Humans; D006887:Hydroxycholecalciferols / Q000627:therapeutic use; D007676:Kidney Failure, Chronic / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011446:Prospective Studies; D006435:Renal Dialysis; D017582:Renal Replacement Therapy / Q000009:adverse effects*; D012189:Retrospective Studies; D012307:Risk Factors; D012606:Scotland / Q000453:epidemiology; D055815:Young Adult
chemical_list: D050071:Bone Density Conservation Agents; D006887:Hydroxycholecalciferols; C008088:alfacalcidol
keywords: CKD–MBD; fracture; haemodialysis; kidney transplantation; renal replacement therapy