Increased risk of hip fracture among patients with end-stage renal disease

Background. Although patients with end-stage renal disease (ESRD) are at in creased risk for bone loss, the risk of hip fracture in this population is not known. We compared the risk of hip Fracture among dialysis patients wit h the general population. Methods. We used data from the United States Renal Data System (USRDS) to i dentify all new Caucasian dialysis patients who began dialysis between Janu ary 1, 1989, and December 31, 1996. All hip fractures occurring during this time period were ascertained. The observed number of hip fractures was com pared with the expected number based on the experience of residents of Olms tead County (MN, USA). Standardized incidence ratios were calculated as the ratio between observed and expected. The risk attributable to ESRD was cal culated as the difference between the observed and expected rate of hip fra cture per 1000 person-years. Results. The number of dialysis patients was 326,463 (55.9% male and 44.1% female). There were 6532 hip fractures observed during the follow-up period of 643,831 patient years. The overall incidence of hip fracture was 7.35 p er 1000 person years for males and 13.63 per 1000 person years for females. The overall relative risk for hip fracture was 4.44 (95% CI, 4.16 to 3.75) for male dialysis patients and 4.40 (95% CI, 3.17 to 4.64) for female dial ysis patients compared with people of the same sex in the general populatio n. While the age-specific relative risk of hip fracture was highest in the youngest age groups, the added risks of fracture associated with dialysis r ose steadily with increasing age. The relative risk of hip fracture increas ed as time since first dialysis increased. Conclusions. The overall risk of hip fracture among Caucasian patients with ESRD is considerably higher than in the general population, independent of age and gender.