SCM14: Are Hip Fractures Increasing in Patients on RRT?
Drs. Anna Mathew and Shailaja Chidella (AM&SC), from Hofstra North Shore-LIJ School of Medicine, discuss their abstract for the National Kidney Foundation’s 2014 Spring Clinical Meetings (SCM14), Increasing Hip Fracture Rates in Patients Receiving Hemodialysis and Peritoneal Dialysis, with Dr. Matt Sparks (eAJKD), eAJKD Advisory Board member. (Note: Dr. Kenar Jhaveri, eAJKD Editor, is one of the authors of this abstract.)
eAJKD: Why don’t you tell us a little about your research and abstract being presented at NKF 2014 Spring Clinical Meetings?
AM&SC: Hip fractures are an important cause of mortality and hospitalization in the US, and this study builds on our previous work which has described a sharp increase in fracture rates seen in all dialysis patients between years 1992 to 2004.
In this current study, we used data from the United States Renal Data System (USRDS) to look at temporal trends in hip fracture rates in hemodialysis compared to peritoneal dialysis patients. Since we used data from 1992 to 2009, we had a large number patients included in our analysis (846,958 HD and 88,263 PD). We found that patients on HD were at about 1.5 times higher risk for hip fracture than patients on PD at any time point in the study. The hip fracture rates in all dialysis patients rose sharply from 1992 to 2004, and have stabilized since that time.
We broke down the study population into different subgroups to see if we could identify which patients are at the highest risk of hip fracture. It turned out that dialysis patients with risk factors for osteoporosis (white race, and older than 65 years) were at the highest risk for hip fracture. It ‘s important to note that during this same time period, the general population was being screened and treated for osteoporosis and their hip fracture rates were steadily declining.
eAJKD: Can you speculate as to reason why fractures have increased in patients on HD and PD despite more attention given to bone-mineral metabolism to this population of patients?
AM&SC: In our study, the hip fracture risk was carried almost entirely by white patients, and those ages 65 or older. This is a demographic profile seen in osteoporosis. In dialysis patients, intact parathyroid hormone (iPTH) is a common targeted for suppression treatment, to manage the high turnover hyperparathyroid bone disease we often see in this patient population. We think that the rise in incidence of hip fractures may be related to over suppression of iPTH, and that ESRD patients with concomitant low bone volume may have been at highest risk for hip fracture.
eAJKD: Where do you and your group go from here?
AM&SC: Our study has generated a number of hypotheses about possible risk factors for hip fracture in ESRD patients, and also reasons why PD patients are at lower risk for fracture than HD patients. We are planning a study which looks at these specific risk factors in more detail. We have shown that different demographic groups of dialysis patients have different risks of hip fracture. Even though the same “one size fits all” approach is used now to manage renal bone disease, we believe that more individualized therapy is extremely important.
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