Impact of chronic kidney disease on mortality in fragility fractures patients
Abstract
Introduction: Chronic Kidney Disease (CKD) affects 5-10% of the world population and is associated with increased fragility fracture risk and mortality. The objective of this study is to measure impact of CKD stage on one-year mortality in fragility fracture patients.
Methods: 5320 fragility fracture patients seen by Aneurin Bevan Fracture Liaison Service (AB-FLS) between January 2022 and June 2024 were reviewed retrospectively. 1718 patients’ fragility fracture were excluded due to non-availability of estimated glomerular filtration rate (eGFR). CKD stages were classified based on eGFR (mL/min/1.73 m²) values: Stage 2 (60–89); Stage 3A (45–59); Stage B (30-44), Stages 4 (15-29) and stage 5 (<15). Stage 4 and 5 were combined for statistical analyses.
Results: A total of 3602 fragility fracture patients were included (mean age 81.0±9.3 years). Overall, 19.6% of patients (n=706/3602) had preserved renal function (eGFR ≥ 90), while 80.4% (n=2,896/3602) had chronic kidney disease (CKD) stage 2 or above. Among patients with CKD stage ≥2, 68.9% (n=1,996) required hospital admission.
CKD stage 2 was present in 43.7% (n=1,573/3602), with a mean age of 80.1±9.3 years. Over one-third of patients (36.7%, n=1,323/3602) had CKD stage ≥3 and were significantly older (mean age 84.4±8.0 years; p<0.0001).
CKD stages 3, 4, and 5 accounted for 32.5% (n=1,172/3602), 3.4% (n=121/3602), and 0.8% (n=30/3602) of the cohort, respectively. There were no significant sex differences between CKD stage 2 and stage 3 (p=0.72) or between stage 2 and stages 4/5 (p=0.25).
Mean haemoglobin levels declined with increasing CKD severity (stage 2: 126.3±17.7 g/L; stage 3: 120.8±18.8 g/L; stage 4/5: 112.2±18.6 g/L; p<0.0001).
Overall Mortality among patients with CKD stage 2-5 was 31% (n=907/2896) and one-year mortality was 22.0% (n=638/2896).
One-year mortality increased progressively with CKD severity: stage 2 = 17.2% (n=272/1573); stage 3A = 21.2% (n=157/740); stage 3B = 32.6.2% (n=141/432) and stage 4/5 was 41.7% (n=63/151). Mortality was significantly higher in stage 3 compared with stage 2 (p=0.02) and markedly higher in stages 4/5 compared with stage 2 (p<0.0001).
Conclusion: This study demonstrates that declining kidney function is associated with markedly higher mortality following fragility fractures, with risk rising sharply from CKD stage 3B. The combination of impaired renal function and high mortality complicates osteoporosis treatment, highlighting the need for enhanced multidisciplinary care including dedicated FLS pharmacist involvement rather than a default approach of therapeutic nihilism.