Hospitalizations for fractures after renal transplantation in the United States

PURPOSE: To investigate the incidence, risk factors, and associated mortali ty of fractures in renal transplant recipients. METHODS: Retrospective registry study of 33,479 patients in the United Stat es Renal Data System (USRDS) who received kidney transplants between I July 1994 and 30 June 1997. Associations with hospitalizations for a primary di scharge diagnosis of fractures (all causes) were assessed. RESULTS: Renal transplant recipients had an adjusted incidence ratio for fr actures of 4.59 (95% confidence interval 3.29 to 6.31). In multivariate ana lysis, recipients with prevalent fractures, as well as recipients who were Caucasian, women, in the lower quartiles of recipient weight (< 95.9 kg), h ad end stage renal disease caused by diabetes, and had prolonged pretranspl ant dialysis were at increased risk for hospitalization because of fracture s after transplantation. Recipients hospitalized for hip fracture,, had dec reased all-cause survival (hazard ratio for mortality 1.60, 95% CI 1.13 to 2.26) in Cox Regression analysis, CONCLUSIONS: In the early post,transplant course (<3 years), renal transpla nt recipients had a greater incidence of fractures than the general populat ion, which were associated with decreased patient survival. Preventive effo rts should focus on recipients with the risk factors identified in this ana lysis, most of which can be easily obtained through history and physical ex amination. (C) 2001 Elsevier Science Inc. All rights reserved.