Elsevier

Mayo Clinic Proceedings

Volume 83, Issue 11, November 2008, Pages 1231-1239
Mayo Clinic Proceedings

ORIGINAL ARTICLE
Use of Renal Function Measurements for Assessing Fracture Risk in Postmenopausal Women

https://doi.org/10.4065/83.11.1231Get rights and content

OBJECTIVE

To determine whether factors associated with moderate chronic kidney disease can be used to independently predict fracture risk in postmenopausal white women by analyzing the effect of adding renal function measurements to traditional risk factors (eg, age, body weight, bone mineral density) for fracture risk assessment.

PARTICIPANTS AND METHODS

In a prospective, population-based cohort study, postmenopausal women residing in Rochester, MN, with baseline measurements of bone mineral density and renal function were followed up for as long as 25 years for occurrence of fractures. Participants were enrolled in 1980-1984 or 1991-1993, and outcomes were analyzed in 2007. Standardized incidence ratios were used to compare the number of observed fractures with the number of predicted fractures, and potential risk factors were evaluated with Andersen-Gill time-to-fracture regression models.

RESULTS

During 5948 person-years of follow-up of 427 women, 254 women (59.5%) experienced a total of 563 fractures, 394 (70.0%) of which resulted from moderate trauma. Excluding incidentally diagnosed fractures, the 186 clinically diagnosed fractures were statistically undifferentiated from the 195 predicted fractures (standardized incidence ratio, 0.95; 95% confidence interval, 0.82-1.10). No significant trends were observed toward increasing fracture risk with inclusion of quintiles of declining renal function (P>.10). In univariate analyses, serum creatinine concentration, creatinine clearance rate, and estimated glomerular filtration rate were associated with greater risk of some fractures. In multivariate analyses, however, decreasing renal function was not found to be a significant risk factor, after adjusting for age, body weight, and bone mineral density.

CONCLUSION

The addition of serum creatinine concentration, creatinine clearance rate, or estimated glomerular filtration rate does not improve fracture risk prediction in postmenopausal white women who have moderate chronic kidney disease. This result can be partly explained by the fact that important risk factors for decreased renal function (eg, advanced age, lower body weight) are already accounted for in most fracture prediction models.

Section snippets

PARTICIPANTS AND METHODS

After approval by the Mayo Clinic Institutional Review Board, participants were recruited from age-stratified random samples of residents of Rochester, MN. Two previously described cohorts were combined for this analysis. Cohort A was recruited from a random sample of Rochester women attended at Mayo Clinic in 1979-1981 who were enrolled between January 4, 1980, and March 25, 1984; women in cohort B were enrolled between September 16, 1991, and April 23, 1993, from among Rochester women sampled

RESULTS

To enroll about 50 women per decade of age in cohort A, 541 women aged 30 years or older were sampled.32 Thirty-eight (7%) of these women were deemed to be ineligible for study, mainly because of dementia. Of the 503 women eligible for cohort A, 304 (60%) agreed to participate.32 Following the same procedure, of 812 eligible women in cohort B, 351 (43%) agreed to participate.33

Of these 655 women, only the 438 (67%) who were postmenopausal (225 in cohort A, 213 in cohort B) were considered for

DISCUSSION

Although BMD measurements by DEXA provide the basis for diagnosing osteoporosis,17 this approach has substantial limitations with respect to assessing future fracture risk.49 Therefore, the World Health Organization has introduced its fracture risk assessment (FRAX) algorithm, which combines femoral neck BMD measurements with clinical risk factors, including age, sex, body mass index, parental history of fracture, personal history of fracture, rheumatoid arthritis or other risk factors for

CONCLUSION

Despite potential limitations, our study data are the only data available on the use of measurements of renal function and eGFR to predict long-term risk of fractures. More importantly, if increases in hip fractures with reduced renal function are caused by bone loss, rather than fall-related factors, one would expect to see an increase in fractures of all types. Instead, we saw no such increase in fractures generally, in moderate trauma fractures, in osteoporotic fractures, or in hip fractures

Acknowledgments

The authors thank Barbara Nolte, RN, for her assistance with data collection, and Mary Roberts for her help in preparing the submitted manuscript.

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    This study was supported by research grants from the National Institutes of Health, US Public Health Service (R01 AR27065, PO1 AG04875, R01 AR30582, and M01 RR00585).

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