Estimated GFR and Fracture Risk: A Population-Based Study

Background and objectives Although patients with ESRD have a higher fracture risk than the general population, there is conflicting evidence regarding fracture incidence in those with CKD. This study sought to determine the association between estimated GFR (eGFR) and fracture rates.Design, setting, participants, & measurements This study identified 1,815,943 community-dwelling adults who had at least one outpatient serum creatinine measurement between 2002 and 2008. Patients with eGFR <15 ml/min per 1.73 m(2) and those who required dialysis were excluded. Incident fractures of the hip, wrist, and vertebrae were identified using diagnostic and procedure codes. Poisson regression was used to determine adjusted rates of each fracture type by eGFR, age, and sex.Results The median age of the cohort was 47 years (interquartile range, 24), and 7.1% had eGFR <60 ml/min per 1.73 m(2). Over a median follow-up of 4.4 years, fracture rates increased with age at all sites. Within each age stratum, unadjusted rates increased with declining eGFR; however, adjusted rates were similar across eGFR categories. For example, among women aged 65-74 years, adjusted hip fracture rates were 3.41 per 1000 person-years (95% confidence interval, 2.30 to 4.53) and 4.58 per 1000 person-years (95% confidence interval, 0.02 to 9.14) in those with eGFR 90 and 15-29 ml/min per 1.73 m(2), respectively. Similar results were observed for wrist and vertebral fractures.Conclusions In contrast to earlier studies, patients with eGFR<60 ml/min per 1.73 m(2) do not appear to have increased rates of hip, wrist, and vertebral fractures independent of age and sex.