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Association of Kidney Function with Incident Hip Fracture in Older Adults

Linda F. Fried^*, Mary Louise Biggs, Michael G. Shlipak, Stephen Seliger, Bryan Kestenbaum^||, Catherine Stehman-Breen^¶, Mark Sarnak^**, David Siscovick, Tamara Harris, Jane Cauley, Anne B. Newman^,|||| and John Robbins^¶¶

^* VA Pittsburgh Healthcare System and Renal-Electrolyte Division and ^|||| Division of Geriatrics, University of Pittsburgh School of Medicine, and Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania; Collaborative Health Studies Coordinating Center, and Department of Medicine, University of Washington, Seattle, Washington; VA Medical Center San Francisco and Department of Medicine, University of California, San Francisco, San Francisco, California; Division of Nephrology, University of Maryland School of Medicine, Baltimore, Maryland; ^|| Division of Nephrology, University of Washington School of Medicine, Seattle, Washington; ^¶ Amgen, Thousand Oaks, California; ^** Department of Medicine, Tufts-New England Medical Center, Boston, Massachusetts; National Institute on Aging, National Institutes of Health, Bethesda, Maryland; and ^¶¶ Department of Medicine, University of California, Davis, Davis, California

Address correspondence to: Dr. Linda Fried, VA Pittsburgh Healthcare System, University Drive C, Mailstop 111F-U, Pittsburgh, PA 15240. Phone: 412-688-6181; Fax: 412-688-6908; E-mail: linda.fried{at}med.va.gov

Received for publication May 31, 2006. Accepted for publication October 26, 2006.

Kidney dysfunction is associated with bone loss, and patients with ESRD have an increased risk for hip fracture. However, the association of mild to moderate kidney disease with hip fracture has not been studied previously. The association of kidney function with incident hip fracture was examined among participants in the Cardiovascular Health Study, a community-based cohort of older individuals. The primary measure of kidney function was serum cystatin C, a measure that does not depend on lean mass. Hip fractures were identified using International Classification of Diseases, Ninth Revision codes for hospitalizations. A total of 4699 individuals had cystatin C measured in 1992 to 1993 and did not have a hip fracture before cystatin C measurement. The association of kidney function with hip fracture was analyzed with Cox proportional hazards models. Analyses were conducted separately for men and women. After a mean follow-up of 7.1 yr, 195 incident hip fractures occurred in women and 79 occurred in men. Higher cystatin C levels were associated with a higher risk for fracture in women (hazard ratio [HR] 1.26; 95% confidence interval [CI] 1.14 to 1.38 per SD) and in men (HR 1.27; 95% CI 1.11 to 1.46). After multivariable adjustment, higher cystatin C levels were significantly associated with hip fracture in women (HR 1.16; 95% CI 1.01, 1.33) but not in men (HR 1.14; 95% CI 0.86 to 1.52), although the magnitude of the association was similar. Kidney dysfunction, as assessed by cystatin C, is associated with an increased risk for hip fracture. Further studies are needed to evaluate potential mediators of this relationship and to assess whether interventions can decrease this risk.

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