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This Article Full Text Full Text (PDF) All Versions of this Article: ASN.2005111194v1 17/11/3223    most recent Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Nickolas, T. L. Articles by Shane, E. Search for Related Content PubMed PubMed Citation Articles by Nickolas, T. L. Articles by Shane, E. Related Collections Related Article

Relationship between Moderate to Severe Kidney Disease and Hip Fracture in the United States

Thomas L. Nickolas^*, Donald J. McMahon and Elizabeth Shane

^* Division of Nephrology and Division of Endocrinology, Department of Medicine, Columbia University Medical Center, New York, New York

Address correspondence to: Dr. Thomas L. Nickolas, Division of Nephrology, Department of Medicine, Columbia University Medical Center, New York, NY 10032. Phone: 212-305-3273; Fax: 212-305-6692; E-mail: tln2001{at}colubmia.edu

Received for publication November 17, 2005. Accepted for publication August 16, 2006.

People with ESRD are at a high risk for hip fracture. However, the effect of moderate to severe chronic kidney disease (CKD) on hip fracture risk has not been well studied. As part of the Third National Health and Nutrition Examination Survey, information on both kidney function and history of hip fracture was obtained. This survey is a complex, multistage, probability sample of the US noninstitutionalized civilian population and was conducted between 1988 and 1994. A history of hip fracture was identified from the response to a questionnaire that was administered to all participants. There were 159 cases of hip fracture. There was a significantly increased likelihood of reporting a hip fracture in participants with estimated GFR <60 ml/min (odds ratio [OR] 2.12; 95% confidence interval [CI] 1.18 to 3.80). In younger participants (aged 50 to 74 yr), the prevalence of CKD was approximately three-fold higher in those with a history of hip fracture versus in those without a history of hip fracture (19.0 versus 6.2%, respectively; P = 0.04). In multivariate logistic regression analysis, only the presence of CKD (OR 2.32; 95% CI 1.13 to 4.74), a reported history of osteoporosis (OR 2.52; 95% CI 1.08 to 5.91), and low physical activity levels (OR 2.10; 95% CI 1.03 to 4.27) were associated with a history of hip fracture. There is a significant association between hip fracture and moderate to severe degrees of CKD, particularly in younger individuals, that is independent of traditional risk factors for hip fracture.

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Copyright © 2008 by the American Society of Nephrology. Online ISSN: 1533-3450 Print ISSN: 1046-6673