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Chronic kidney disease–related osteoporosis is associated with incident frailty among patients with diabetic kidney disease: a propensity score–matched cohort study

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Abstract

Summary

Chronic kidney disease (CKD)-related osteoporosis is a major complication in patients with CKD, conferring a higher risk of adverse outcomes. We found that among those with diabetic kidney disease, this complication increased the risk of incident frailty, an important mediator of adverse outcomes.

Introduction

Renal osteodystrophy and chronic kidney disease (CKD)-related osteoporosis increases complications for patients with diabetic kidney disease (DKD). Since musculoskeletal degeneration is central to frailty development, we investigated the relationship between baseline osteoporosis and the subsequent frailty risk in patients with DKD.

Methods

From the Longitudinal Cohort of Diabetes Patients in Taiwan (n = 840,000), we identified 12,027 patients having DKD with osteoporosis and 24,054 propensity score-matched controls having DKD but without osteoporosis. The primary endpoint was incident frailty on the basis of a modified FRAIL scale. Patients were prospectively followed-up until the development of endpoints or the end of this study. The Kaplan-Meier technique and Cox proportional hazard regression were used to analyze the association between osteoporosis at baseline and incident frailty in these patients.

Results

The mean age of the DKD patients was 67.2 years, with 55.4% female and a 12.6% prevalence of osteoporosis at baseline. After 3.5 ± 2.2 years of follow up, the incidence rate of frailty in patients having DKD with osteoporosis was higher than that in DKD patients without (6.6 vs. 5.7 per 1000 patient-year, p = 0.04). A Cox proportional hazard regression showed that after accounting for age, gender, obesity, comorbidities, and medications, patients having DKD with osteoporosis had a significantly higher risk of developing frailty (hazard ratio, 1.19; 95% confidence interval, 1.02–1.38) than those without osteoporosis.

Conclusions

CKD-related osteoporosis is associated with a higher risk of incident frailty in patients with DKD.

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Data availability

The dataset generated during and/or analyzed during the current study are not publicly available but are available from the corresponding author on reasonable request.

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Acknowledgments

We are grateful for the assistance of the Second Core Laboratory, Department of Medical Research of National Taiwan University Hospital and the Genomic Center of National Taiwan University College of Medicine, Taipei, Taiwan.

Funding

The study is financially sponsored by Ministry of Science and Technology, Taiwan (MOST-108-2314-B-002-055-).

Author information

Authors and Affiliations

  1. Department of Internal Medicine, National Taiwan University Hospital BeiHu Branch, Taipei, Taiwan

    C.-T. Chao

  2. Geriatric and Community Medicine Research Center, National Taiwan University Hospital BeiHu Branch, Taipei, Taiwan

    C.-T. Chao

  3. Graduate Institute of Toxicology, National Taiwan University College of Medicine, Taipei, Taiwan

    C.-T. Chao

  4. Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan

    J. Wang & K.-L. Chien

  5. Nephrology division, Department of Internal Medicine, National Taiwan University Hospital YunLin branch, Douliou, YunLin County, Taiwan

    J.-W. Huang

  6. Department of Internal Medicine, National Taiwan University Hospital ChuTung branch, Zhudong, HsinChu County, Taiwan

    D.-C. Chan

  7. Department of Internal Medicine, National Taiwan University Hospital HsinChu branch, HsinChu City, Taiwan

    K.-Y. Hung

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  1. C.-T. Chao
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Consortia

on behalf of the COhort of GEriatric Nephrology in NTUH (COGENT) study group

Corresponding author

Correspondence to J.-W. Huang.

Ethics declarations

This study has been approved by the institutional review board of National Taiwan University Hospital (NO. 201802063W). Its protocol adhered to the Declaration of Helsinki. Informed consent was waived due to data anonymity based on the recommendation of the institutional review board.

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Chao, CT., Wang, J., Huang, JW. et al. Chronic kidney disease–related osteoporosis is associated with incident frailty among patients with diabetic kidney disease: a propensity score–matched cohort study. Osteoporos Int 31, 699–708 (2020). https://doi.org/10.1007/s00198-020-05353-9

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