Hemodialysis Patients Suffering Fewer Hip Fractures

Hip fracture rates over time differ markedly between Medicare patients on hemodialysis (HD) and those without end-stage renal disease (ESRD), according to a new study.

The study, which examined data from Medicare beneficiaries aged 66 years and older, found that hip fracture rates increased relatively rapidly among HD patients until 2004 and then decreased relatively rapidly compared with non-ESRD beneficiaries, concluded Thomas J. Arneson, MD, of the Chronic Disease Research Group, Minneapolis Medical Research Foundation, and colleagues.

The adjusted hip fracture rate among HD patients increased from 23.4 events per 1,000 person-years in 1993 to a high of 41.4 events per 1,000 person-years in 2004, and then decreased to 31.9 events per 1,000 person-years by 2010, the researchers reported in the American Journal of Kidney Diseases (2013;62:747-754). The adjusted hip fracture rate in Medicare non-ESRD patients rose slightly from 9.6 to 10.6 events per 1,000 person-years from 1993 to 1996 and then decreased to 8.0 events per 1,000 person-years by 2010.

“The trend is different in the general non-ESRD Medicare population; it shows a small steady decrease in hip fracture rates starting in the late 1990s, suggesting that the observed trend in the hemodialysis population is due to factors specific to hemodialysis patient characteristics and clinical management,” the researchers wrote.

Dr. Arneson's group noted that changes in the management of mineral bone disease in chronic kidney disease patients may partially explain the hip fracture trends in dialysis cohorts. These changes include the use of cinacalcet, a calcimimetic agent approved in March 2004, and lanthanum carbonate, a non-calcium phosphate binder approved in October 2004. “Possibly, the steep downward trend in hip fracture rates in hemodialysis patients from 2004 to 2010 may be explained in part by the market introduction of one or both agents; however, this is speculative,” they wrote.

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