Competing Risks of Fracture and Death in Older Adults with Chronic Kidney Disease

Competing Risks of Fracture and Death in Older Adults with Chronic Kidney Disease Osteoporotic fractures are a major source of morbidity, mortality, and cost in older adults. Because fracture risk increases exponentially with age, multimorbidity is the norm for most older adults and can complicate assessment of the risks and benefits of osteoporosis screening and treatment. One of the most common but understudied such comorbidities is chronic kidney disease (CKD).Older adults with CKD have a greater risk of death at worsening levels of kidney function than those without CKD. Because impaired kidney function reduces bone quality and increases risk of falls, CKD has also been associated with fractures, although prior studies did not take into account competing mortality risk, which can bias fracture risk prediction. Furthermore, it is unknown whether CKD in an older adult with mild, age‐related decline in kidney function independently increases the risk of fracture or whether the presence of CKD is merely a marker of other chronic illnesses associated with fracture. Precise estimates of the risk of fracture at all levels of CKD, accounting for competing mortality risk and other risk factors, are therefore needed. Finally, we have insufficient evidence to understand whether race or ethnicity modifies the fracture risk associated with CKD. This is especially important because http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Journal of American Geriatrics Society Wiley

Competing Risks of Fracture and Death in Older Adults with Chronic Kidney Disease

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Publisher
Wiley Subscription Services, Inc., A Wiley Company
Copyright
© 2018 American Geriatrics Society and Wiley Periodicals, Inc.
ISSN
0002-8614
eISSN
1532-5415
D.O.I.
10.1111/jgs.15256
Publisher site
See Article on Publisher Site

Abstract

Osteoporotic fractures are a major source of morbidity, mortality, and cost in older adults. Because fracture risk increases exponentially with age, multimorbidity is the norm for most older adults and can complicate assessment of the risks and benefits of osteoporosis screening and treatment. One of the most common but understudied such comorbidities is chronic kidney disease (CKD).Older adults with CKD have a greater risk of death at worsening levels of kidney function than those without CKD. Because impaired kidney function reduces bone quality and increases risk of falls, CKD has also been associated with fractures, although prior studies did not take into account competing mortality risk, which can bias fracture risk prediction. Furthermore, it is unknown whether CKD in an older adult with mild, age‐related decline in kidney function independently increases the risk of fracture or whether the presence of CKD is merely a marker of other chronic illnesses associated with fracture. Precise estimates of the risk of fracture at all levels of CKD, accounting for competing mortality risk and other risk factors, are therefore needed. Finally, we have insufficient evidence to understand whether race or ethnicity modifies the fracture risk associated with CKD. This is especially important because

Journal

Journal of American Geriatrics SocietyWiley

Published: Jan 1, 2018

Keywords: ; ;

References

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