Introduction
Material and methods
Subjects
Blood chemistry
Kidney function
Incident fracture registration
Bone mineral density
Statistics
Results
Age 75 (n 981) | Age 80 (n 685) | Age 85 (n 365) | ||||
---|---|---|---|---|---|---|
Mean | (SD) | Mean | (SD) | Mean | (SD) | |
Age (years) | 75.2 | (0.1) | 80.2 | (0.2) | 85.2 | (0.14) |
BMI (kg/m2) | 26.3 | (4.2) | 26.0 | (4.2) | 25.4 | (4.0) |
Weight (kg) | 68 | (12) | 66 | (11) | 64 | (11) |
Height (cm) | 161 | (6) | 159 | (6) | 158 | (6) |
Total body BMD (g/cm2) | 1.007 | (0.097) | 0.997 | (0.097) | 0.991 | (0.102) |
Femoral neck BMD (g/cm2) | 0.765 | (0.137) | 0.715 | (0.128) | 0.689 | (0.136) |
Osteoporosis# | 255 | (26) | 282 | (41) | 175 | (48) |
P-cysC*(mg/L) | 1.06 | (0.31) | 1.18 | (0.34) | 1.28 | (0.39) |
eGFRcysC (mL/min/1.73m2) | 63 | (18) | 54 | (15) | 47 | (14) |
S-PTH* (pmol/L) | 4.2 | (2.3) | 4.6 | (2.7) | 4.2 | (3.1) |
P-Phosphate* (mmol/L) | 1.11 | (0.23) | 1.09 | (0.19) | 1.13 | (0.17) |
P-Calcium (mmol/L) | 2.40 | (0.07) | 2.41 | (0.13) | 2.34 | (0.09) |
S-25(OH)D (nmol/L) | 62 | (19) | 78 | (30) | 79 | (26) |
n | (%) | n | (%) | n | (%) | |
Current smoker | 136 | (14) | 73 | (11) | 20 | (6) |
Steroid user | 29 | (3) | 33 | (5) | 17 | (5) |
Bisphosphonate user | 32 | (3) | 47 | (7) | 44 | (12) |
Normal kidney function | Intermediate kidney function | Poor kidney function | ||||
---|---|---|---|---|---|---|
n | (%) | n | (%) | n | (%) | |
Estimated at age 75 | 570 | (58%) | 252 | (26%) | 159 | (16%) |
Estimated at age 80 | 236 | (35%) | 265 | (39%) | 184 | (27%) |
No with a fracture between 75 and 80 years | ||||||
Hip fracture | 21 | (4%) | 18 | (7%) | 7 | (4%) |
Osteoporotic fracture | 86 | (15%) | 54 | (21%) | 29 | (18%) |
No with a fracture between 80 and 85 years* | ||||||
Hip fracture | 17 | (7%) | 27 | (10%) | 16 | (9%) |
Osteoporotic fracture | 47 | (20%) | 70 | (26%) | 41 | (22%) |
Kidney function and imminent and short-term fracture risk
Imminent, short- and long-term fracture risk | ||||
---|---|---|---|---|
Kidney function age 75 | Kidney function age 80 | |||
Intermediate (n = 252) | Poor (n = 159) | Intermediate (n = 265) | Poor (n = 184) | |
HR (95% CI) | HR (95% CI) | HR (95% CI) | HR (95% CI) | |
One-year risk | ||||
N fractures | 3 | 0 | 4 | 1 |
Hip Fracture | 0.97 (0.25–3.73) | NA | 1.19 (0.27–5.30) | NA |
Adjusted-model 1 | 0.88 (0.22–3.53) | NA | 1.95 (0.35–10.96) | NA |
Adjusted-model 2 | 1.01 (0.23–4.38) | NA | 1.94 (0.35–10.92) | NA |
N fractures | 12 | 6 | 11 | 9 |
Osteoporotic Fracture | 1.36 (0.67–2.79) | 1.11 (0.44–2.75) | 0.98 (0.41–2.30) | 1.18 (0.48–2.91) |
Adjusted-model 1 | 1.36 (0.64–2.88) | 1.22 (0.48–3.07) | 1.17 (0.43–3.17) | 1.41 (0.48–4.13) |
Adjusted-model 2 | 1.42 (0.65–3.11) | 0.69 (0.20–2.36) | 1.17 (0.43–3.18) | 0.89 (0.27–2.93) |
Two-year risk | ||||
N fractures | 13 | 1 | 8 | 10 |
Hip Fracture | 3.68 (1.52–8.87)* | NA | 1.20 (0.42–3.47) | 2.23 (0.81–6.14) |
Adjusted-model 1 | 3.59 (1.44–8.93)* | NA | 1.37 (0.42–4.39) | 2.00 (0.61–6.56) |
Adjusted-model 2 | 4.15 (1.57–10.96)* | NA | 1.32 (0.37–4.77) | 1.82 (0.50–6.68) |
N fractures | 29 | 13 | 29 | 20 |
Osteoporotic Fracture | 2.23 (1.34–3.71)* | 1.62 (0.85–3.11) | 1.31 (0.74–2.31) | 1.34 (0.72–2.49) |
Adjusted-model 1 | 2.22 (1.29–3.79)* | 1.78 (0.92–3.44) | 1.42 (0.76–2.68) | 1.26 (0.61–2.60) |
Adjusted-model 2 | 2.21 (1.27–3.87)* | 1.18 (0.53–2.63) | 1.40 (0.73–2.69) | 0.87 (0.39–1.93) |
Three-year risk | ||||
N fractures | 15 | 4 | 15 | 10 |
Hip Fracture | 2.86 (1.34–6.11)* | 1.25 (0.40–3.89) | 1.52 (0.67–3.47) | 1.51 (0.61–3.72) |
Adjusted-model 1 | 2.97 (1.36–6.51)* | 1.40 (0.45–4.38) | 1.55 (0.64–3.75) | 1.13 (0.40–3.24) |
Adjusted-model 2 | 3.12 (1.36–7.14)* | 1.62 (0.50–5.20) | 1.53 (0.60–3.89) | 1.01 (0.33–3.03) |
N fractures | 35 | 19 | 42 | 26 |
Osteoporotic Fracture | 1.74 (1.12–2.69)* | 1.54 (0.91–2.63) | 1.32 (0.83–2.13) | 1.21 (0.72–2.06) |
Adjusted-model 1 | 1.82 (1.15–2.87)* | 1.75 (1.02–3.01)* | 1.34 (0.81–2.24) | 0.91 (0.48–1.71) |
Adjusted-model 2 | 1.85 (1.16–2.96)* | 1.41 (0.76–2.60) | 1.37 (0.81–2.32) | 0.68 (0.34–1.35) |
Five-year risk | ||||
N fractures | 18 | 7 | 27 | 16 |
Hip Fracture | 2.00 (1.06–3.75)* | 1.32 (0.56–3.10) | 1.47 (0.80–2.69) | 1.30 (0.66–2.57) |
Adjusted -model 1 | 2.05 (1.07–3.94)* | 1.44 (0.61–3.42) | 1.56 (0.81–3.00) | 1.20 (0.56–2.59) |
Adjusted -model 2 | 2.00 (1.00–3.98)* | 1.41 (0.55–3.57) | 1.56 (0.80–3.06) | 1.11 (0.50–2.44) |
N fractures | 54 | 29 | 70 | 41 |
Osteoporotic Fracture | 1.50 (1.06–2.10)* | 1.37 (0.90–2.09) | 1.38 (0.95–2.00) | 1.20 (0.79–1.82) |
Adjusted -model 1 | 1.56 (1.10–2.22)* | 1.52 (0.99–2.32) | 1.37 (0.92–2.03) | 0.97 (0.61–1.56) |
Adjusted -model 2 | 1.51 (1.04–2.18)* | 1.23 (0.76–2.01) | 1.41 (0.94–2.10) | 0.82 (0.50–1.35) |
Kidney function and long-term fracture risk
Potential influence of survival on risk estimates
Reduced kidney function and osteoporosis
Fracture type | Reduced kidney function, without osteoporosis (n = 261) | Normal kidney function with osteoporosis (n = 161) | Reduced kidney function with osteoporosis (n = 94) | |||
---|---|---|---|---|---|---|
HR (95% CI) | p value | HR (95% CI) | p value | HR (95% CI) | p value | |
N fractures | 11 | 15 | 11 | |||
Hip | 3.26 (1.13–9.39) | 0.028 | 7.26 (2.64–19.99) | < 0.001 | 10.11 (3.51–29.14) | < 0.001 |
Adjusted* | 3.08 (1.05–9.07) | 0.041 | 6.47 (2.25–18.66) | 0.001 | 9.42 (3.25–27.30) | < 0.001 |
N fractures | 47 | 40 | 23 | |||
Osteoporotic | 1.71 (1.13–2.58) | 0.012 | 2.41 (1.57–3.72) | < 0.001 | 2.66 (1.60–4.43) | < 0.001 |
Adjusted* | 1.66 (1.08–2.54) | 0.020 | 2.14 (1.34–3.40) | 0.001 | 2.53 (1.52–4.23) | < 0.001 |