Prevalence of Chronic Kidney Disease in patients with Fragility Fractures: Two-year retrospective study
Abstract
Introduction: Chronic Kidney Disease (CKD) is associated with abnormal bone metabolism and increased fragility fracture risk. However, many older people often have both CKD and osteoporosis, go undiagnosed and untreated. The objective of this study is to measure prevalence of CKD among patients presenting with fragility fractures.
Methods: 3839 fragility fracture patients seen by Aneurin Bevan Fracture Liaison Service (AB-FLS) between January 2022 and December 2023 were reviewed retrospectively. 1325 patients’ fragility fracture were excluded due to non-availability of estimated glomerular filtration rate (eGFR). 2614 patients with fragility fractures were assessed for stage of CKD based on eGFR. CKD stages were classified based on eGFR (mL/min/1.73 m²) values: Stage 2 (60–89); Stage 3 (30–59); Stages 4 (15-29) and stage 5 (<15).
Results: A total of 2,614 fragility fracture patients were included (mean age 80.2 ± 9.6 years). Mean eGFR was 60 mL/min/1.73 m². Overall, 20.1% of patients (n=527/2,614) had preserved renal function (eGFR ≥ 90), while 79.9% (n=2,087/2,614) had chronic kidney disease (CKD) stage 2 or above. Overall, 57.4% of fragility fracture patients with CKD stage 2 or above required hospital admission.
CKD stage 2 was present in 42.9% of patients (n=1,124/2,614), with a mean age of 79.8±9.6 years (range 50.4–102.9). Over one-third of fragility fracture patients (36.8%, n=963/2,614) had CKD stage 3 or above and were significantly older, with a mean age of 84.4±8.0 years (range 50.3–104.4); the difference in mean age between CKD groups was statistically significant (p < 0.0001).
CKD stage 3, 4 and 5 were present in 32.5% (n=851/2614), 3.5% (n=91/2614) and 0.8% (n=21/2614) of patients respectively.
Nearly half of hip fracture patients had CKD stage 3 or above (48.6%, n=522/1,075).
Routine blood investigations showed mean haemoglobin of 124 g/L (range 49–192), mean corpuscular volume of 93.2 fL (60–142), corrected calcium of 2.38 mmol/L (1.62–3.39), phosphate of 1.09 mmol/L (0.10–2.97), alkaline phosphatase of 106 U/L (11–1086), and creatinine of 87 µmol/L (7–810).
Conclusion: Over one-third (36.8%) of the fragility fracture had CKD stage 3 or above and were significantly older. CKD stage 3 or above was observed in nearly half of the hip/femur fracture patients. More research is needed to close this gap, so we can better understand how to manage bone health in older people living with CKD.