Authors’ reply

Excerpt

We thank Lai et al. [1] for their comments regarding our paper, “Polypharmacy, chronic kidney disease, and incident fragility fracture: a prospective cohort study.”[2] We agree that death risk after hip fracture is high; however, Lai’s interpretations {Fig. 1 [1]} may be too simplistic. Not only hip fractures and their consequences but also pre-existing poor health is likely to contribute to excess deaths after hip fracture, because patients with hip fracture are generally more functionally impaired and have more comorbidities than similar-aged patients without hip fracture. In fact, our previous cohort study of hemodialysis patients found that the association between hip fracture and all-cause mortality is greatly attenuated, but still significant after adjusting for premorbid conditions [3]. Underlying health conditions are also associated with polypharmacy and falls. Thus, we propose adding “pre-existing poor health” to Lai’s Figure [1] (Fig. 1).

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