Abstract
Summary
Chronic kidney disease increases the risk of hip fractures which can be promoted by dementia. We here showed that dementia increased the risk of hip fractures in dialysis patients, but in a similar manner than without dialysis. Attention should be paid to dementia to prevent hip fractures.
Introduction
Hip fractures (HF) are associated with significant morbidity and is further increased in patients with chronic kidney disease (CKD). Dementia, frequent in CKD, might be a risk factor for HF. We here aimed to assess if dementia increased the risk of hip fracture in CKD.
Methods
The study was derived from the French National Database of Hospitalization. Data were obtained over the period 2011–2013. Three populations of subjects >60 years were extracted. Hip fractures, dialysis, and dementia were the main studied factors. The three populations were crossed to estimate the fracture risk based on dementia or dialysis, adjusted for age and gender. The fracture risk was calculated using a multiple logistic regression model.
Results
Over this period, 213,180 patients experienced a HF, 660,434 patients were diagnosed for dementia, and 47,430 patients were on dialysis. There was an effect of age and gender on the incidence of HF and dementia. In CKD patients, the risk of HF was significantly higher in demented patients compared to those without dementia: OR 2.0 [95 % CI 1.7–2.4], this being the same for men (OR 2.4 [1.8–3.1]) and women (OR 2.6 [2.0–3.3]) and at any age. However, the adjusted risk for HF in demented patients on dialysis therapy is not different than in demented patients without CKD (OR 1.3 [1.0–1.6]).
Conclusions
Dementia significantly increases the risk of HF in patients on dialysis, but this risk in demented patients is equally high whether receiving dialysis therapy or not. These results highlight dementia as a major risk factor for HF in dialysis and indicate that reduction of fracture risk should include dementia as a risk factor.
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Acknowledgments
This work has been supported by the Collège Français des Médecins Rhumatologues (www.cfmr.fr).
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Milka Maravic has been an employee of AstraZeneca France, from 12 November 2014. AstraZeneca was not involved in this manuscript. No funding from AstraZeneca was received for this manuscript. Agnes Ostertag, Pablo Urena and Martine Cohen-Solal declared that they have no conflict of interest.
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Maravic, M., Ostertag, A., Urena, P. et al. Dementia is a major risk factor for hip fractures in patients with chronic kidney disease. Osteoporos Int 27, 1665–1669 (2016). https://doi.org/10.1007/s00198-015-3429-y
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DOI: https://doi.org/10.1007/s00198-015-3429-y