Osteoporosis International

, Volume 25, Issue 1, pp 159–165 | Cite as

Incidence and risk factors for hip fractures in dialysis patients

  • M. MaravicEmail author
  • A. Ostertag
  • P. U. Torres
  • M. Cohen-Solal
Original Article



This study described the incidence of hip fractures, associated diseases, and related costs generated in dialysis versus non-dialysis patients.


Skeletal fractures are a great concern in chronic kidney disease patients and, in particular, hip fractures that enhance the mortality. We aimed to accurately determine the incidence of hip fractures and associated diseases and to calculate the costs generated in dialysis patients.


We obtained data from the 2010 French National Hospital Database. We first extracted the hospital stays related to hip fractures as a primary diagnosis according to the ICD-10 codes and then the hospitalizations for dialysis. We compared the frequency of comorbidities in both populations.


Among the 88,962 patients who suffered from hip fractures, 362 were on dialysis. The incidence was significantly higher in dialysis patients (x4) compared to non-dialysis patients. Women on dialysis experienced hip fractures at an earlier age than non-dialysis women. Dementia was identified as a major risk factor in the dialysis patients (72 vs. 26 %, p < 0.0001). Moreover, diabetes and cardiovascular diseases were comorbidities strongly associated with hip fractures in both gender, but hypertension and malnutrition were observed exclusively in men on dialysis. Mortality rate and length of hospital stay were increased (5 days) in both genders.


The incidence of hip fractures is increased in dialysis patients, affecting a larger percentage of men and women on dialysis than in the non-dialysis population and enhancing the financial burden and mortality. Dementia is a major risk factor for hip fractures in dialysis patients in addition to diabetes and cardiovascular diseases.


Dialysis Hip fractures Hospitals costs 



This work was supported by the Collège Français des Médecins Rhumatologues (

Conflicts of interest



  1. 1.
    Kanis JA, Oden A, Johnell O, De Laet C, Jonsson B, Oglesby AK (2003) The components of excess mortality after hip fracture. Bone 32:468–473PubMedCrossRefGoogle Scholar
  2. 2.
    Roche JJ, Wenn RT, Sahota O, Moran CG (2005) Effect of comorbidities and postoperative complications on mortality after hip fracture in elderly people: prospective observational cohort study. BMJ 331:1374PubMedCrossRefGoogle Scholar
  3. 3.
    Giversen IM (2007) Time trends of mortality after first hip fractures. Osteoporos Int 18:721–732PubMedCrossRefGoogle Scholar
  4. 4.
    Haentjens P, Magaziner J, Colón-Emeric CS, Vanderschueren D, Milisen K, Velkeniers B, Boonen S (2010) Meta-analysis: excess mortality after hip fracture among older women and men. Ann Intern Med 152:380–390PubMedCentralPubMedCrossRefGoogle Scholar
  5. 5.
    Bliuc D, Nguyen ND, Milch VE, Nguyen TV, Eisman JA, Center JR (2009) Mortality risk associated with low-trauma osteoporotic fracture and subsequent fracture in men and women. JAMA 301:513–521PubMedCrossRefGoogle Scholar
  6. 6.
    LeBlanc ES, Hillier TA, Pedula KL et al (2011) Hip fracture and increased short-term but not long-term mortality in healthy older women. Arch Intern Med 171:1831–1837PubMedCentralPubMedCrossRefGoogle Scholar
  7. 7.
    Alem AM, Sherrard DJ, Gillen DL, Weiss NS, Beresford SA, Heckbert SR, Wong C, Stehman-Breen C (2000) Increased risk of hip fracture among patients with end-stage renal disease. Kidney Int 58:396–399PubMedCrossRefGoogle Scholar
  8. 8.
    Stehman-Breen CO, Sherrard DJ, Alem AM, Gillen DL, Heckbert SR, Wong CS, Ball A, Weiss NS (2000) Risk factors for hip fracture among patients with end-stage renal disease. Kidney Int 58:2200–2205PubMedCrossRefGoogle Scholar
  9. 9.
    Bass E, French DD, Bradham DD, Rubenstein LZ (2007) Risk-adjusted mortality rates of elderly veterans with hip fractures. Ann Epidemiol 17:514–519PubMedCrossRefGoogle Scholar
  10. 10.
    Ball AM, Gillen DL, Sherrard D, Weiss NS, Emerson SS, Seliger SL, Kestenbaum BR, Stehman-Breen C (2002) Risk of hip fracture among dialysis and renal transplant recipients. JAMA 288:3014–3018PubMedCrossRefGoogle Scholar
  11. 11.
    Dooley AC, Weiss NS, Kestenbaum B (2008) Increased risk of hip fracture among men with CKD. Am J Kidney Dis 51:38–44PubMedCrossRefGoogle Scholar
  12. 12.
    Jadoul M, Albert JM, Akiba T, Akizawa T, Arab L, Bragg-Gresham JL, Mason N, Prutz KG, Young EW, Pisoni RL (2006) Incidence and risk factors for hip or other bone fractures among hemodialysis patients in the Dialysis Outcomes and Practice Patterns Study. Kidney Int 70:1358–1366PubMedCrossRefGoogle Scholar
  13. 13.
    London GM (2011) Soft bone–hard arteries: a link? Kidney Blood Press Res 34:203–208PubMedCrossRefGoogle Scholar
  14. 14.
    Group KDIGOKC-MW (2009) KDIGO clinical practice guideline for the diagnosis, evaluation, prevention, and treatment of chronic kidney disease–mineral and bone disorder (CKD-MBD). Kidney Int Suppl S1–130Google Scholar
  15. 15.
    Mahmoodi BK, Matsushita K, Woodward M et al (2012) Associations of kidney disease measures with mortality and end-stage renal disease in individuals with and without hypertension: a meta-analysis. Lancet 380:1649–61PubMedCrossRefGoogle Scholar
  16. 16.
    Maravic M, Ostertag A, Cohen-Solal M (2011) Subtrochanteric/femoral shaft versus hip fractures: incidences and identification of risk factors. J Bone Miner Res 27:130–137CrossRefGoogle Scholar
  17. 17.
    Jamal SA, Hayden JA, Beyene J (2007) Low bone mineral density and fractures in long-term hemodialysis patients: a meta-analysis. Am J Kidney Dis 49:674–681PubMedCrossRefGoogle Scholar
  18. 18.
    Fox CS, Matsushita K, Woodward M et al (2012) Associations of kidney disease measures with mortality and end-stage renal disease in individuals with and without diabetes: a meta-analysis. Lancet 380:1662–73PubMedCentralPubMedCrossRefGoogle Scholar
  19. 19.
    Jamal SA, Leiter RE, Jassal V, Hamilton CJ, Bauer DC (2006) Impaired muscle strength is associated with fractures in hemodialysis patients. Osteoporos Int 17:1390–1397PubMedCrossRefGoogle Scholar
  20. 20.
    Kurella Tamura M, Yaffe K (2011) Dementia and cognitive impairment in ESRD: diagnostic and therapeutic strategies. Kidney Int 79:14–22PubMedCrossRefGoogle Scholar
  21. 21.
    Post JB, Morin KG, Sano M, Jegede AB, Langhoff E, Spungen AM (2012) Increased presence of cognitive impairment in hemodialysis patients in the absence of neurological events. Am J Nephrol 35:120–126PubMedCrossRefGoogle Scholar
  22. 22.
    O'Hare AM, Walker R, Haneuse S, Crane PK, McCormick WC, Bowen JD, Larson EB (2012) Relationship between longitudinal measures of renal function and onset of dementia in a community cohort of older adults. J Am Geriatr Soc 60:2215–2222PubMedCentralPubMedCrossRefGoogle Scholar
  23. 23.
    Cheng KC, Chen YL, Lai SW, Mou CH, Tsai PY, Sung FC (2012) Patients with chronic kidney disease are at an elevated risk of dementia: a population-based cohort study in Taiwan. BMC Nephrol 13:129PubMedCentralPubMedCrossRefGoogle Scholar
  24. 24.
    Davey A, Elias MF, Robbins MA, Seliger SL, Dore GA (2012) Decline in renal functioning is associated with longitudinal decline in global cognitive functioning, abstract reasoning and verbal memory. Nephrol Dial Transplant. doi: 10.1093/ndt/gfs470
  25. 25.
    Etgen T, Chonchol M, Förstl H, Sander D (2012) Chronic kidney disease and cognitive impairment: a systematic review and meta-analysis. Am J Nephrol 35:474–482PubMedCrossRefGoogle Scholar
  26. 26.
    Griva K, Stygall J, Hankins M, Davenport A, Harrison M, Newman SP (2010) Cognitive impairment and 7-year mortality in dialysis patients. Am J Kidney Dis 56:693–703PubMedCrossRefGoogle Scholar
  27. 27.
    Bugnicourt JM, Godefroy O, Chillon JM, Choukroun G, Massy ZA (2013) Cognitive disorders and dementia in CKD: the neglected kidney–brain axis. J Am Soc Nephrol 24:353–63PubMedCrossRefGoogle Scholar
  28. 28.
    Baker NL, Cook MN, Arrighi HM, Bullock R (2011) Hip fracture risk and subsequent mortality among Alzheimer's disease patients in the United Kingdom, 1988–2007. Age Ageing 40:49–54PubMedCrossRefGoogle Scholar

Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2013

Authors and Affiliations

  • M. Maravic
    • 1
    Email author
  • A. Ostertag
    • 2
  • P. U. Torres
    • 3
  • M. Cohen-Solal
    • 2
  1. 1.Department of Medical InformationHôpital Léopold-BellanParisFrance
  2. 2.Sorbonne Paris Cité, Bone and Joint LaboratoryINSERM U606—University Paris DiderotParisFrance
  3. 3.Service of Nephrology and DialysisClinique du LandySaint OuenFrance

Personalised recommendations