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

Thomas J. Arneson, Shuling Li, Jiannong Liu, Ryan D. Kilpatrick, Britt B. Newsome, Wendy L. St. Peter

Research output: Contribution to journalArticlepeer-review

56 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)747-754
Number of pages8
JournalAmerican Journal of Kidney Diseases
Volume62
Issue number4
DOIs
StatePublished - Oct 2013

Bibliographical note

Funding Information:
Support: This study was supported by a research contract from Amgen Inc, Thousand Oaks, CA. All authors have agreed to the content of this manuscript. Minneapolis Medical Research Foundation had the right to seek publication of this work regardless of sponsor approval.

Keywords

  • Hemodialysis
  • hip fracture rates
  • mineral and bone disorder

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