Patients with moderate to severe chronic kidney disease (CKD) are an increased risk for nonspinal fractures, a new systematic review and meta-analysis confirms.

Patients with CKD stages 3a to 5D had a significant 2.4-fold increased risk for hip fracture and a significant 1.5-fold increased risk for nonvertebral fractures, Tatiane Vilaca, MD, of the University of Sheffield, Metabolic Bone Centre, in Sheffield, United Kingdom, and colleagues reported in the American Journal of Kidney Diseases. The hip fracture finding was based on a meta-analysis of 10 studies involving 5,798,566 patients with CKD G3a-G5D, including 363,410 with hip fracture. The nonvertebral fracture finding emerged from a meta-analysis of 4 studies involving 464,978 patients with CKD G3a-G5D, including 115,284 with fractures in the forearm, shoulder, leg, or other nonspinal areas. In line with previous research, a subgroup of patients receiving dialysis had an especially high 4-fold increased risk for fracture.

As other studies have found, patients with greater decline in estimated glomerular filtration rate had a higher risk for fractures. At the hip, patients with CKD younger than 65 years had a 7.7-fold higher risk for fracture compared with the general population, whereas patients older than 65 years had a 2.1-fold higher risk. No significant sex differences were observed.

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“These findings suggest that fracture prevention should be a consideration in patients with kidney disease at any age,” Dr Vilaca’s team wrote. Furthermore, “having CKD G3a-G5D should be considered an additional risk factor for fractures, beyond the traditional ones.”

As with the general population, low bone mineral density (BMD) can develop in patients with CKD. CKD also is associated with diabetes, inflammation, and requirement for glucocorticoid treatment, all of which affect bone health. In addition, CKD mineral and bone disorders may affect bone turnover, volume, mineralization, microstructure, and mechanical properties of bone. The study investigators could not assess the effects of BMD, biochemical abnormalities, renal osteodystrophy, frailty, falls, or medications on risk for fractures, which is a limitation.

The treatment of bone fragility in CKD is not established and requires further study, according to the study authors.

Disclosure: This clinical trial was supported by Amgen. Please see the original reference for a full list of authors’ disclosures.


Vilaca T, Salam S, Schini M, et al. Risks of hip and nonvertebral fractures in patients with CKD G3a-G5D: a systematic review and meta-analysis. Am J Kidney Dis. 2020;76:521-532. doi:10.1053/j.ajkd.2020.02.450