Rasheeda K Hall1,2, Richard Sloane3, Carl Pieper4, Courtney Van Houtven5, Joanne LaFleur6,7, Robert Adler8,9, Cathleen Colón-Emeric1,3,5. 1. Geriatric Research, Education and Clinical Center, Durham Veterans Affairs, Durham, North Carolina. 2. Division of Nephrology, Department of Medicine, Duke University Medical Center, Durham, North Carolina. 3. Division of Geriatrics, Department of Medicine, Duke University Medical Center, Durham, North Carolina. 4. Department of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina. 5. Health Services Research and Development, Durham Veterans Affairs, Durham, North Carolina. 6. Department of Pharmacotherapy, University of Utah, Salt Lake City, Utah. 7. Salt Lake City Veterans Affairs Medical Center, Salt Lake City, Utah. 8. Hunter Holmes McGuire Veterans Affairs Medical Center, Richmond, Virginia. 9. School of Medicine, Virginia Commonwealth University, Richmond, Virginia.
Abstract
OBJECTIVES: To examine whether chronic kidney disease (CKD) at any stage is associated with fracture risk after adjusting for competing mortality and to determine whether age or race modify the relationship between CKD and fracture risk. DESIGN: Prospective cohort study. SETTING: Department of Veterans Affairs (VA) national healthcare system. PARTICIPANTS: Men receiving VA primary care aged 65 and older with no history of fracture or osteoporosis therapy (N = 712, 918). MEASUREMENTS: We determined CKD stage from baseline estimated glomerular filtration rate (eGFR). Participants were followed for up to 10 years for occurrence of any fracture or death. We ascertained fractures and covariates from VA medical records and Medicare claims. RESULTS: Of the 356,459 older veterans with CKD (defined as eGFR <60 mL/min per 1.73 m2 ), 15.7% (n = 56,032) experienced a fracture, and 43.0% (n = 153,438) died over a median time at risk of 5.2 years. Veterans with CKD Stages 3 to 5 had a greater risk of death than those without CKD, which biased estimates from traditional survival models. Competing risk models showed that Stage 3 CKD was associated with greater hazard (adjusted subdistribution hazard ratio (sdHR) = 1.07, 95% confidence interval (CI) = 1.02-1.11) of fracture (than those without CKD) and a trend toward greater hazard for Stage 4 (sdHR = 1.07, 95% CI = 0.94-1.22) and Stage 5 (sdHR = 1.31, 95% CI = 0.97-1.77) CKD. Age, race, and bone mineral density did not modify the relationship between CKD and fracture risk. CONCLUSIONS: In older male veterans, CKD, including Stage 3, is associated with a moderately greater fracture risk irrespective of age, race, or bone mineral density.
OBJECTIVES: To examine whether chronic kidney disease (CKD) at any stage is associated with fracture risk after adjusting for competing mortality and to determine whether age or race modify the relationship between CKD and fracture risk. DESIGN: Prospective cohort study. SETTING: Department of Veterans Affairs (VA) national healthcare system. PARTICIPANTS: Men receiving VA primary care aged 65 and older with no history of fracture or osteoporosis therapy (N = 712, 918). MEASUREMENTS: We determined CKD stage from baseline estimated glomerular filtration rate (eGFR). Participants were followed for up to 10 years for occurrence of any fracture or death. We ascertained fractures and covariates from VA medical records and Medicare claims. RESULTS: Of the 356,459 older veterans with CKD (defined as eGFR <60 mL/min per 1.73 m2 ), 15.7% (n = 56,032) experienced a fracture, and 43.0% (n = 153,438) died over a median time at risk of 5.2 years. Veterans with CKD Stages 3 to 5 had a greater risk of death than those without CKD, which biased estimates from traditional survival models. Competing risk models showed that Stage 3 CKD was associated with greater hazard (adjusted subdistribution hazard ratio (sdHR) = 1.07, 95% confidence interval (CI) = 1.02-1.11) of fracture (than those without CKD) and a trend toward greater hazard for Stage 4 (sdHR = 1.07, 95% CI = 0.94-1.22) and Stage 5 (sdHR = 1.31, 95% CI = 0.97-1.77) CKD. Age, race, and bone mineral density did not modify the relationship between CKD and fracture risk. CONCLUSIONS: In older male veterans, CKD, including Stage 3, is associated with a moderately greater fracture risk irrespective of age, race, or bone mineral density.
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