Incidence of fractures in middle-aged individuals with early chronic kidney disease: a population-based analysis of CARTaGENE

Nephrol Dial Transplant. 2020 Oct 1;35(10):1712-1721. doi: 10.1093/ndt/gfz259.


Background: Previous studies evaluating fractures in chronic kidney disease (CKD) have mostly focused on hip or major fractures in aged populations with moderate to advanced CKD. We aimed at evaluating the association between early CKD and fracture incidence at all sites across age and sex in middle-aged individuals.

Methods: We analyzed CARTaGENE, a prospective population-based survey of 40- to 69-year-old individuals from Quebec (Canada). Estimated glomerular filtration rate (eGFR) at baseline was evaluated categorically or continuously using restricted cubic splines. Fractures at any site (except toes, hand and craniofacial) for up to 7 years of follow-up were identified through administrative databases using a validated algorithm. Adjusted Cox models were used to evaluate the association of CKD with fracture. Interaction terms for age and sex were also added.

Results: A total of 19 391 individuals (756 CKD Stage 3; 9114 Stage 2; 9521 non-CKD) were included and 829 fractures occurred during a median follow-up of 70 months. Compared with the median eGFR of 90 mL/min/1.73 m2, eGFRs of ≤60 mL/min/1.73 m2 were associated with increased fracture incidence in unadjusted and adjusted models [adjusted hazard ratio (HR) = 1.25 (95% confidence interval 1.05-1.49) for 60 mL/min/1.73 m2; 1.65 (1.14-2.37) for 45 mL/min/1.73 m2]. The eGFR was linearly associated with fracture incidence <75 mL/min/1.73 m2 [HR = 1.18 (1.04-1.34) per 10 mL/min/1.73 m2 decrease] but not above [HR = 0.98 (0.91-1.06) per 10 mL/min/1.73 m2 decrease). The effect of decreased eGFR on fracture incidence was more pronounced in younger individuals [HR = 2.45 (1.28-4.67) at 45 years; 1.11 (0.73-1.67) at 65 years] and in men.

Conclusions: Even early CKD increases fracture incidence, especially in younger individuals and in men.

Keywords: chronic kidney disease; fracture; mineral and bone disorders.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Canada / epidemiology
  • Female
  • Fractures, Bone / epidemiology*
  • Fractures, Bone / etiology
  • Fractures, Bone / pathology
  • Glomerular Filtration Rate
  • Humans
  • Incidence
  • Longitudinal Studies
  • Male
  • Middle Aged
  • Prospective Studies
  • Renal Insufficiency, Chronic / complications*
  • Risk Factors

Grant support