Increased incidence of hip fractures in dialysis patients with low serum parathyroid hormone

To study the complications of renal osteodystrophy in patients with end-sta ge renal disease, we reviewed the incidence of hip fractures in our outpati ent dialysis population from 1988 to 1998. One thousand two hundred seventy -two patients were treated for a total of 4,039 patient-years; 56 hip fract ures were documented during this period. The incidence of hip fractures was many times greater in the dialysis patients than in the general population in each of the age-, race-, and sex-matched subgroups. The 1-year mortalit y rate from the hip fracture event was nearly two and a half times greater in the dialysis patients compared with the general population. The incidenc e of hip fractures in the first half of the decade was similar to that obse rved in the second half. When parathyroid hormone (PTH) levels were evaluat ed, we determined that patients with lower serum PTH levels were more likel y to sustain a hip fracture than patients with higher PTH levels (P < 0.006 ). In addition, we determined that patients with lower PTH levels had an ea rlier mortality than patients with higher PTH levels (P < 0.03). We conclud e that despite more aggressive therapy directed toward bone health in our d ialysis patients in recent years, the incidence of hip fractures and their devastating morbidity and mortality remained unchanged over the past decade . Lower PTH levels may predispose to earlier mortality. (C) 2000 by the Nat ional Kidney Foundation, Inc.