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The FRAX® as a predictor of mortality in Japanese incident hemodialysis patients: an observational, follow-up study

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An Editorial to this article was published on 12 May 2015

Abstract

The World Health Organization Fracture Risk Assessment Tool (FRAX®) was recently developed to estimate the 10-year absolute risk of osteoporotic fracture among the general population. However, the evidence for its use in chronic kidney disease patients has been lacking, and the association between the FRAX® and mortality is unknown. Therefore, a hospital-based, prospective, cohort study was conducted to evaluate the predictive ability of the FRAX® for mortality in hemodialysis patients. A total of 252 patients who had been started on maintenance hemodialysis, 171 men and 81 women, with a mean age of 67 ± 14 years, was studied. The endpoint was defined as all-cause death. The Cox proportional hazards model was used to calculate hazard ratios and 95 % confidence intervals. During the mean follow-up period of 3.4 ± 2.7 years, 61 deaths occurred. The median (interquartile range) of the FRAX® for major osteoporotic fracture was 6.9 (4.6–12.0)  % in men and 19.0 (7.6–33.0)  % in women. Cumulative survival rates at 5 years after starting dialysis, with the FRAX® levels above and below the median, were 51.9 and 87.9 %, respectively, in men and 67.4 and 83.7 %, respectively, in women. Overall, in men, the multivariate Cox regression analyses revealed that the log-transformed FRAX® remained an independent predictor of death after adjusting by confounding variables. However, in women, the significant association between the FRAX® value and the outcome was eliminated if age was put into these models. Among Japanese hemodialysis patients, the FRAX® seems to be useful for predicting death, especially in men.

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Acknowledgments

There are no potential conflicts of interest relevant to this article to report. Parts of this study were presented in abstract form at the Annual Meeting of ASN, Nov 5-10, 2013, Atlanta, Georgia, USA.

Conflict of interest

All authors have no conflicts of interest to declare in connection with this paper.

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Authors and Affiliations

  1. Division of Nephrology, Toho University Ohashi Medical Center, 2-17-6 Ohashi, Meguro-Ku, Tokyo, 153-8515, Japan

    Toshihide Hayashi, Nobuhiko Joki, Yuri Tanaka, Masaki Iwasaki, Shun Kubo, Takasuke Asakawa, Ai Matsukane, Yasunori Takahashi & Hiroki Hase

  2. Division of Dialysis, Nissan Tamagawa Hospital, Tokyo, Japan

    Yoshihiko Imamura

  3. Hirahata Clinic, Tokyo, Japan

    Koichi Hirahata

Authors
  1. Toshihide Hayashi
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  2. Nobuhiko Joki
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  3. Yuri Tanaka
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  4. Masaki Iwasaki
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  10. Koichi Hirahata
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  11. Hiroki Hase
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Correspondence to Nobuhiko Joki.

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Hayashi, T., Joki, N., Tanaka, Y. et al. The FRAX® as a predictor of mortality in Japanese incident hemodialysis patients: an observational, follow-up study. J Bone Miner Metab 33, 674–683 (2015). https://doi.org/10.1007/s00774-014-0631-5

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  • DOI: https://doi.org/10.1007/s00774-014-0631-5

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