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Kristine E. Ensrud, MD, MPH; Li-Ying Lui, MA, MS; Brent C. Taylor, PhD; Areef Ishani, MD, MS; Michael G. Shlipak, MD, MPH; Katie L. Stone, PhD; Jane A. Cauley, DrPH; Sophie A. Jamal, MD, PhD; Diana M. Antoniucci, MD; Steven R. Cummings, MD; for the Study of Osteoporotic Fractures Research Group

Arch Intern Med. 2007;167(2):133-139.

Background  An increased rate of hip fractures has been reported in patients with end-stage renal disease, but the effect of less severe renal dysfunction on fracture risk is uncertain.

Methods  We conducted a case-cohort study within a cohort of 9704 women 65 years or older to compare baseline renal function (estimated glomerular filtration rate [eGFR] using the Cockcroft-Gault equation) in 149 women who subsequently had hip fractures and 150 women who subsequently had vertebral fractures with eGRF in 396 randomly selected women.

Results  In models adjusted for age, weight, and calcaneal bone density, decreasing eGFR was associated with increased risk of hip fracture. Compared with women with an eGFR 60 mL/min per 1.73 m² or greater, the hazard ratio (95% confidence interval [CI]) for hip fracture was 1.57 (95% CI, 0.89-2.76) in those with an eGFR 45 to 59 mL/min per 1.73 m² and 2.32 (95% CI, 1.15-4.68) in those with an eGFR less than 45 mL/min per 1.73 m² (P for trend = .02). In particular, women with a reduced eGFR were at increased risk of trochanteric hip fracture (adjusted hazard ratio, 3.93 [95% CI, 1.37-11.30] in women with an eGFR 45-59 mL/min per 1.73 m² and 7.17 [95% CI, 1.93-26.67] in women with an eGFR <45 mL/min per 1.73 m²; P for trend = .004). Renal function was not independently associated with risk of vertebral fracture (adjusted odds ratio, 1.08 [95% CI, 0.61-1.92] in women with an eGFR 45-59 mL/min per 1.73 m² and 1.33 [95% CI, 0.63-2.80] in women with an eGFR <45 mL/min per 1.73 m²; P for trend = .47).

Conclusion  Older women with moderate renal dysfunction are at increased risk of hip fracture.

Author Affiliations: Center for Chronic Disease Outcomes Research, VA Medical Center, Minneapolis (Drs Ensrud, Taylor, and Ishani), and Department of Medicine (Drs Ensrud and Ishani) and Division of Epidemiology and Community Health, University of Minnesota (Dr Ensrud), Minneapolis; San Francisco Coordinating Center, California Pacific Medical Center Research Institute (Ms Lui, and Drs Stone and Cummings); Departments of Medicine (Drs Shlipak and Antoniucci) and Epidemiology and Biostatistics (Dr Shlipak), University of California, San Francisco, and General Internal Medicine,VA Medical Center, San Francisco, Calif (Dr Shlipak); Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pa (Dr Cauley); and Department of Medicine, Division of Endocrinology and Metabolism, St Michael's Hospital, University of Toronto, Toronto, Ontario (Dr Jamal). Dr Antoniucci is also now with the Endocrine Research Unit, VA Medical Center, San Francisco, Calif.

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RELATED LETTERS

Glomerular Filtration Rate Results Reflect Estimation
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Arch Intern Med. 2007;167(17):1905-1906.
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Glomerular Filtration Rate Results Reflect Estimation—Reply
Kristine E. Ensrud, Areef Ishani, Brent C. Taylor, and Li-Yung Lui
Arch Intern Med. 2007;167(17):1906.
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