Trends in hip fracture rates in US hemodialysis patients, 1993-2010

Am J Kidney Dis. 2013 Oct;62(4):747-54. doi: 10.1053/j.ajkd.2013.02.368. Epub 2013 Apr 28.


Background: Changes in mineral and bone disorder treatment patterns and demographic changes in the dialysis population may have influenced hip fracture rates in US dialysis patients in 1993-2010.

Study design: Retrospective follow-up study analyzing trends over time in hospitalized hip fracture rates.

Setting & participants: Using Medicare data, we created 2 point-prevalent study cohorts for each study year. Hemodialysis cohorts included patients with Medicare as primary payer receiving hemodialysis in the United States on January 1 of each year; non-end-stage renal disease (ESRD) cohorts included Medicare beneficiaries 66 years or older on January 1 of each year.

Factors: Age, sex, race, primary cause of ESRD, dual Medicare/Medicaid enrollment status, comorbid conditions.

Outcomes: Hip fracture rates.

Measurements: Unadjusted hip fracture rates measured using number of events per 1,000 person-years in each year, then adjusted for patient characteristics. Poisson models estimated strata-specific event rates.

Results: The observed number of first hospitalized hip fracture events and the adjusted hip fracture rate increased steadily from 1993 (831 events; 11.9/1,000 person-years), peaked in 2004 (3,256 events; 21.9/1,000 person-years), and decreased through 2010 (2,912 events; 16.6/1,000 person-years). The trend for the subset of hemodialysis patients 66 years or older was similar to the trend for the full hemodialysis cohort; however, it differed markedly in magnitude and pattern from the non-ESRD Medicare cohort, for which rates were substantially lower and slowly decreasing since 1996.

Limitations: Unable to provide causal explanations for observed changes; hip fractures identified through inpatient episodes; results do not describe hemodialysis patients without Medicare Parts A and B; laboratory values unavailable in the Medicare data set.

Conclusions: Temporal trends in hip fracture rates among Medicare hemodialysis patients differ markedly from the steadily decreasing trend in non-ESRD Medicare beneficiaries, showing a relatively rapid increase until 2004 and relatively rapid decrease thereafter. Further research is needed to define associated factors.

Keywords: Hemodialysis; hip fracture rates; mineral and bone disorder.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Female
  • Follow-Up Studies
  • Hip Fractures / epidemiology*
  • Hip Fractures / etiology*
  • Humans
  • Kidney Failure, Chronic / complications*
  • Kidney Failure, Chronic / therapy*
  • Male
  • Middle Aged
  • Renal Dialysis*
  • Retrospective Studies
  • Survival Rate
  • Time Factors
  • United States