The hip fracture rate among older dialysis patients is still higher now than it was in the 1990s, but the fractures are less deadly than they once were, researchers reported.
The hip fracture rate in these patients steadily rose until 2004, when the rate was 41% higher than 1996, and since then the rate declined from that peak, but is still 25% higher than it was in 1996. The 30-day mortality after hip fracture declined from 20% in 1996 to 16% in 2009.
Researchers insisted, "Hip fracture incidence rates remain higher today than in patients reaching end stage renal disease in 1996, despite multiple purported improvements in the management of chronic kidney disease-mineral and bone disorder." Age did not appear to play a role in the outcomes as patients initiating dialysis in the 1996-1999 had a median age of 75 years, and those in the 2005-2009 were about 77 years of age.
"What this study tells me," said Allan Jhagroo, MD, assistant professor of medicine at the University of Wisconsin, Madison, "is that we are really not doing a very good job in preventing fractures in these end stage renal disease patients. While the fracture rates are improving recently, we still haven't gotten back to where we were more than 15 years ago."
The decrease in 30-day mortality may be due to better treatment of post-fracture complications. People really don't die from hip fractures. They die from heart attacks or pneumonia or things like that. It may be the care they are receiving for those things are the cause of the decrease in mortality.
ESRD patients are five times more likely to experience a hip fracture than age and sex matched healthy adults. Over the years, treatments to prevent fractures have been added to patient regimens, including vitamin D, noncalcium-containing phosphate binders and calcimimetics.