Top

Osteoporosis International

Published in:

Open Access 01-01-2020 | Osteoporosis | Original Article

Kidney function and its association to imminent, short- and long-term fracture risk—a longitudinal study in older women

Authors: L. Malmgren, F.E. McGuigan, A. Christensson, K.E. Akesson

Published in: Osteoporosis International | Issue 1/2020

Abstract

Summary

Reduced kidney function is associated with an increased fracture risk, although the relationship between an age-related decline and fractures needs further investigation. We followed kidney function and fracture risk for 10 years. A mild-moderate decline in kidney function was associated with fracture, but not in advanced age.

Introduction

With age, kidney function declines. Though well known that chronic kidney disease is associated with increased fracture risk, the extent to which the typical age-related decline contributes is unclear. In the OPRA cohort, a longitudinal study of older non-selected women, we investigated the association between kidney function and fracture.

Methods

Cystatin C–based kidney function estimates were available at age 75 (n = 981) and 80 (n = 685). Women were categorized by kidney function: normal (CKD stages 1 and 2), mild-moderate (3a), poor (3b-5), and imminent, short- and long-term fracture risk investigated. BMD measurements and kidney function for risk prediction were also evaluated; women were categorized by both reduced kidney function (stages 3–5) and osteoporosis status.

Results

In the short term, 2–3 years, mild-moderate kidney dysfunction was associated with the highest risk increase: osteoporotic fractures (2 years HR_adj 2.21, 95% CI 1.27–3.87) and also up to 5 years (between 75 and 80 years) (HR_adj 1.51, 1.04–2.18). Hip fracture risk was similarly increased. This association was not observed from age 80 nor for women with poorest kidney function. Reduced kidney function was associated with higher risk even without osteoporosis (osteoporotic fracture; HR_adj 1.66, 1.08–2.54); risk increased by having both osteoporosis and reduced function (HR_adj 2.53, 1.52–4.23).

Conclusion

Older women with mild-moderate reduction of kidney function are at increased risk of fractures, but not those with the worst function. Our findings furthermore confirm the value of osteoporosis assessment and it is possible that in this age group, age-related decline of kidney function has limited contribution compared with BMD.

Available only for authorised users

Kanis JA, Johnell O, Oden A, Sembo I, Redlund-Johnell I, Dawson A, De Laet C, Jonsson B (2000) Long-term risk of osteoporotic fracture in Malmo. Osteoporos Int: J established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA 11(8):669–674CrossRef

Lindeman RD, Tobin JD, Shock NW (1984) Association between blood pressure and the rate of decline in renal function with age. Kidney Int 26(6):861–868CrossRef

KDIGO (2009) clinical practice guideline for the diagnosis, evaluation, prevention, and treatment of Chronic Kidney Disease-Mineral and Bone Disorder (CKD-MBD). Kidney Int Suppl 76:s1–s130. https://doi.org/10.1038/ki.2009.188 CrossRef

KDIGO (2012) Clinical practice guideline for the evaluation and management of chronic kidney disease (2013). Kidney Int Suppl 3(1):19–63 and 73-90

Ensrud KE, Parimi N, Cauley JA, Ishani A, Slinin Y, Hillier TA, Taylor BC, Steffes M, Cummings SR, Study of Osteoporotic Fractures G (2013) Cystatin C and risk of hip fractures in older women. J Bone Miner Res 28(6):1275–1282. https://doi.org/10.1002/jbmr.1858 CrossRefPubMedPubMedCentral

Kinsella S, Chavrimootoo S, Molloy MG, Eustace JA (2010) Moderate chronic kidney disease in women is associated with fracture occurrence independently of osteoporosis. Nephron Clinical practice 116(3):c256–c262. https://doi.org/10.1159/000317207 CrossRefPubMed

LaCroix AZ, Lee JS, Wu L, Cauley JA, Shlipak MG, Ott SM, Robbins J, Curb JD, Leboff M, Bauer DC, Jackson RD, Kooperberg CL, Cummings SR, Women’s Health Initiative O (2008) Cystatin-C, renal function, and incidence of hip fracture in postmenopausal women. J Am Geriatr Soc 56 (8):1434–1441. doi:https://doi.org/10.1111/j.1532-5415.2008.01807.x CrossRef

Ensrud KE, Lui LY, Taylor BC, Ishani A, Shlipak MG, Stone KL, Cauley JA, Jamal SA, Antoniucci DM, Cummings SR (2007) Renal function and risk of hip and vertebral fractures in older women. Arch Intern Med 167(2):133–139. https://doi.org/10.1001/archinte.167.2.133 CrossRefPubMed

Robertson L, Black C, Fluck N, Gordon S, Hollick R, Nguyen H, Prescott G, Marks A (2018) Hip fracture incidence and mortality in chronic kidney disease: the GLOMMS-II record linkage cohort study. BMJ Open 8(4):e020312. https://doi.org/10.1136/bmjopen-2017-020312 CrossRefPubMedPubMedCentral

10.

Kim SM, Long J, Montez-Rath M, Leonard M, Chertow GM (2016) Hip fracture in patients with non-dialysis-requiring chronic kidney disease. J Bone Miner Res: the Off J Am Soc Bone Miner Res 31(10):1803–1809. https://doi.org/10.1002/jbmr.2862 CrossRef

11.

Malmgren L, McGuigan FE, Berglundh S, Westman K, Christensson A, Akesson K (2015) Declining estimated glomerular filtration rate and its association with mortality and comorbidity over 10 years in elderly women. Nephron 130(4):245–255. https://doi.org/10.1159/000435790 CrossRefPubMed

12.

Malmgren L, McGuigan F, Christensson A, Akesson KE (2017) Reduced kidney function is associated with BMD, bone loss and markers of mineral homeostasis in older women: a 10-year longitudinal study. Osteoporos Int J established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA 28(12):3463–3473. https://doi.org/10.1007/s00198-017-4221-y CrossRef

13.

Gerdhem P, Ivaska KK, Alatalo SL, Halleen JM, Hellman J, Isaksson A, Pettersson K, Vaananen HK, Akesson K, Obrant KJ (2004) Biochemical markers of bone metabolism and prediction of fracture in elderly women. J Bone Miner Res: Off J Am Soc Bone Miner Res 19(3):386–393. https://doi.org/10.1359/jbmr.0301244 CrossRef

14.

Fliser D, Ritz E (2001) Serum cystatin C concentration as a marker of renal dysfunction in the elderly. Am J Kidney Dis : Off J Natl Kidney Found 37(1):79–83CrossRef

15.

Shlipak MG, Sarnak MJ, Katz R, Fried LF, Seliger SL, Newman AB, Siscovick DS, Stehman-Breen C (2005) Cystatin C and the risk of death and cardiovascular events among elderly persons. N Engl J Med 352(20):2049–2060. https://doi.org/10.1056/NEJMoa043161 CrossRefPubMed

16.

Inker LA, Schmid CH, Tighiouart H, Eckfeldt JH, Feldman HI, Greene T, Kusek JW, Manzi J, Van Lente F, Zhang YL, Coresh J, Levey AS (2012) Estimating glomerular filtration rate from serum creatinine and cystatin C. N Engl J Med 367(1):20–29. https://doi.org/10.1056/NEJMoa1114248 CrossRefPubMedPubMedCentral

17.

Buchebner D, McGuigan F, Gerdhem P, Malm J, Ridderstrale M, Akesson K (2014) Vitamin D insufficiency over 5 years is associated with increased fracture risk-an observational cohort study of elderly women. Osteoporos Int 25(12):2767–2775. https://doi.org/10.1007/s00198-014-2823-1 CrossRef

18.

Jonsson B, Gardsell P, Johnell O, Redlund-Johnell I, Sernbo I (1994) Remembering fractures: fracture registration and proband recall in southern Sweden. J Epidemiol Community Health 48(5):489–490. https://doi.org/10.1136/jech.48.5.489 CrossRefPubMedPubMedCentral

19.

Lenora J, Akesson K, Gerdhem P (2010) Effect of precision on longitudinal follow-up of bone mineral density measurements in elderly women and men. J Clin Densitometry : Off J Int Soc Clin Densitometry 13(4):407–412. https://doi.org/10.1016/j.jocd.2010.04.004 CrossRef

20.

Tenne M, McGuigan F, Besjakov J, Gerdhem P, Akesson K (2013) Degenerative changes at the lumbar spine--implications for bone mineral density measurement in elderly women. Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA 24(4):1419–1428. https://doi.org/10.1007/s00198-012-2048-0 CrossRef

21.

Naylor KL, Garg AX, Zou G, Langsetmo L, Leslie WD, Fraser LA, Adachi JD, Morin S, Goltzman D, Lentle B, Jackson SA, Josse RG, Jamal SA (2015) Comparison of fracture risk prediction among individuals with reduced and normal kidney function. Clin J Am Soc Nephrol: CJASN 10(4):646–653. https://doi.org/10.2215/cjn.06040614 CrossRefPubMed

22.

West SL, Lok CE, Langsetmo L, Cheung AM, Szabo E, Pearce D, Fusaro M, Wald R, Weinstein J, Jamal SA (2015) Bone mineral density predicts fractures in chronic kidney disease. J Bone Miner Res 30(5):913–919. https://doi.org/10.1002/jbmr.2406 CrossRefPubMed

23.

Fried LF, Biggs ML, Shlipak MG, Seliger S, Kestenbaum B, Stehman-Breen C, Sarnak M, Siscovick D, Harris T, Cauley J, Newman AB, Robbins J (2007) Association of kidney function with incident hip fracture in older adults. J Am Soc Nephrol: JASN 18(1):282–286. https://doi.org/10.1681/asn.2006050546 CrossRefPubMed

24.

Jassal SK, von Muhlen D, Barrett-Connor E (2007) Measures of renal function, BMD, bone loss, and osteoporotic fracture in older adults: the Rancho Bernardo study. J Bone Miner Res : Off J Am Soc Bone Miner Res 22(2):203–210. https://doi.org/10.1359/jbmr.061014 CrossRef

25.

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(1):396–399. https://doi.org/10.1046/j.1523-1755.2000.00178.x CrossRefPubMed

26.

Chen H, Lips P, Vervloet MG, van Schoor NM, de Jongh RT (2018) Association of renal function with bone mineral density and fracture risk in the Longitudinal Aging Amsterdam. Osteoporos Int 29(9):2129–2138. https://doi.org/10.1007/s00198-018-4592-8 CrossRef

27.

Yenchek RH, Ix JH, Shlipak MG, Bauer DC, Rianon NJ, Kritchevsky SB, Harris TB, Newman AB, Cauley JA, Fried LF, Health A, Body Composition S (2012) Bone mineral density and fracture risk in older individuals with CKD. Clin J Am Soc Nephrol 7(7):1130–1136. https://doi.org/10.2215/CJN.12871211 CrossRefPubMedPubMedCentral

28.

Iimori S, Mori Y, Akita W, Kuyama T, Takada S, Asai T, Kuwahara M, Sasaki S, Tsukamoto Y (2012) Diagnostic usefulness of bone mineral density and biochemical markers of bone turnover in predicting fracture in CKD stage 5D patients--a single-center cohort study. Nephrol Dial Transplant 27(1):345–351. https://doi.org/10.1093/ndt/gfr317 CrossRef

29.

Isakova T, Nickolas TL, Denburg M, Yarlagadda S, Weiner DE, Gutierrez OM, Bansal V, Rosas SE, Nigwekar S, Yee J, Kramer H (2017) KDOQI US commentary on the 2017 KDIGO clinical practice guideline update for the diagnosis, evaluation, prevention, and treatment of chronic kidney disease-mineral and bone disorder (CKD-MBD). Am J Kidney Dis: Off J Natl Kidney Found 70(6):737–751. https://doi.org/10.1053/j.ajkd.2017.07.019 CrossRef

30.

Group KDIGOKC-MUW (2017) KDIGO 2017 clinical practice guideline update for the diagnosis, evaluation, prevention, and treatment of chronic kidney disease–mineral and bone disorder (CKD-MBD). Kidney Int Suppl 7:1–59CrossRef

31.

Nickolas TL, Leonard MB, Shane E (2008) Chronic kidney disease and bone fracture: a growing concern. Kidney Int 74(6):721–731. https://doi.org/10.1038/ki.2008.264 CrossRefPubMedPubMedCentral

32.

Miller PD (2014) Chronic kidney disease and the skeleton. Bone research 2:14044. https://doi.org/10.1038/boneres.2014.44 CrossRefPubMedPubMedCentral

33.

Wihlborg A, Akesson K, Gerdhem P (2014) External validity of a population-based study on osteoporosis and fracture. Acta Orthop 85(4):433–437. https://doi.org/10.3109/17453674.2014.920987 CrossRefPubMedPubMedCentral

34.

Gerdhem P, Akesson K (2007) Rates of fracture in participants and non-participants in the Osteoporosis Prospective Risk study. J Bone Joint Surg (Br) 89(12):1627–1631. https://doi.org/10.1302/0301-620x.89b12.18946 CrossRef

Title: Kidney function and its association to imminent, short- and long-term fracture risk—a longitudinal study in older women
Authors: L. Malmgren
F.E. McGuigan
A. Christensson
K.E. Akesson
Publication date: 01-01-2020
Publisher: Springer London
Keywords: Osteoporosis
Osteoporosis
Chronic Kidney Disease
Published in: Osteoporosis International / Issue 1/2020
Print ISSN: 0937-941X
Electronic ISSN: 1433-2965
DOI: https://doi.org/10.1007/s00198-019-05152-x

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Kidney function and its association to imminent, short- and long-term fracture risk—a longitudinal study in older women

Abstract

Summary

Introduction

Methods

Results

Conclusion

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Summary

Introduction

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 1/2020

Impaired geometry, volumetric density, and microstructure of cortical and trabecular bone assessed by HR-pQCT in both sporadic and MEN1-related primary hyperparathyroidism

Systematic review of the effects of bisphosphonates on bone density and fracture incidence in childhood acute lymphoblastic leukaemia

Test systems for the biomechanical evaluation of hip protectors: a systematic review

Parathyroid hormone-dependent familial hypercalcemia with low measured PTH levels and a presumptive novel pathogenic mutation in CaSR

Impact of osteoporotic fracture type and subsequent fracture on mortality: the Tromsø Study

Impaired bone microarchitecture in distal interphalangeal joints in patients with primary hypertrophic osteoarthropathy assessed by high-resolution peripheral quantitative computed tomography