The association between chronic kidney disease, falls, and fractures: a systematic review and meta-analysis

The objective of this systematic review and meta-analysis was to assess whether, and in which degree, CKD was associated with falls and fractures in adults. A systematic search in PubMed, Embase, CINAHL, and The Cochrane Library was performed on 7 September 2018. All retrospective, cross-sectional, and longitudinal studies of adults (18 years of older) that studied the association between CKD, fractures, and falls were included. Additional studies were identified by cross-referencing. A total of 39 publications were included, of which two publications assessed three types of outcome and four publications assessed two types of outcome. Ten studies focused on accidental falling; seventeen studies focused on hip, femur, and pelvis fractures; seven studies focused on vertebral fractures; and thirteen studies focused on any type of fracture without further specification. Generally, the risk of fractures increased when kidney function worsened, with the highest risks in the patients with stage 5 CKD or dialysis. This effect was most pronounced for hip fractures and any type of fractures. Furthermore, results on the association between CKD and accidental falling were contradictory. Compared to the general population, fractures are highly prevalent in patients with CKD. Besides more awareness of timely fracture risk assessment, there also should be more focus on fall prevention.
Source: Osteoporosis International - Category: Orthopaedics Source Type: research

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ConclusionsWe found that among individuals with stage 3 and 4 CKD, PTH was an independent predictor of fractures, vascular events, and death. Additional epidemiologic studies are needed to confirm these findings. If a target PTH range can be confirmed, then randomized placebo-controlled trials will be needed to confirm that treating HPT reduces the risk of fracture, vascular events, and death.
Source: Osteoporosis International - Category: Orthopaedics Source Type: research
Conclusion: The amount of MI, PMI, and AI were not related to CKD. While MCI and TP were significant parameters that showed mandibular cortical situation and trabecular bone pattern, they assess osteoporosis level in a more reliable manner in CKD stages 3–5 patients without dialysis.
Source: Indian Journal of Dental Research - Category: Dentistry Authors: Source Type: research
Authors: Saxena G, Khera P, Jain D Abstract Introduction: Disorders of mineral and bone metabolism in chronic kidney disease (CKD) are associated with increased risk for cardiovascular calcification and osteoporosis. Anemia has been associated with progressive loss of kidney function and increased mortality. Ferric citrate was recently developed, primarily as a novel oral, non-calcium phosphate binder, which has also shown to replenish the iron deficient state of the CKD patients. Material and methods: This prospective study was done on 40 pre-dialysis adult patients of CKD (stage 3-5) from a tertiary care cent...
Source: Journal of the Association of Physicians of India - Category: General Medicine Tags: J Assoc Physicians India Source Type: research
Authors: Nand N, Giri K, Jain D Abstract Introduction: Disorders of mineral and bone metabolism in chronic kidney disease (CKD) are associated with increased risk for cardiovascular calcification and osteoporosis. Anemia has been associated with progressive loss of kidney function and increased mortality. Ferric citrate was recently developed, primarily as a novel oral, non-calcium phosphate binder, which has also shown to replenish the iron deficient state of the CKD patients. Material and methods: This prospective study was done on 40 pre-dialysis adult patients of CKD (stage 3-5) from a tertiary care centre ...
Source: Journal of the Association of Physicians of India - Category: General Medicine Tags: J Assoc Physicians India Source Type: research
AbstractPurpose of ReviewPatients with chronic kidney disease (CKD) have a greatly increased fracture risk compared with the general population. Gonadal hormones have an important influence on bone mineral density (BMD) and fracture risk, and hormone therapies can significantly improve these outcomes. Gonadal dysfunction is a frequent finding in patients with CKD; yet, little is known about the impact of gonadal hormones in the pathogenesis and treatment of bone health in patients with CKD. This systematic review and meta-analysis aimed to examine the effects of gonadal hormones and hormone therapies on bone outcomes in me...
Source: Current Osteoporosis Reports - Category: Orthopaedics Source Type: research
ConclusionsThese results suggest a role for FGF23/klotho axis on bone and vascular metabolism in dialysis populations.
Source: Osteoporosis International - Category: Orthopaedics Source Type: research
We thank Dr. Labriola and Dr. Jadoul for their comments.1 We fully agree with the relevance of falls as a major risk factor of fracture in such patients.2 Falls were mentioned and included in Figure  12 as an important determinant of fractures. However, this issue was not extensively discussed because of few relevant data available in chronic kidney disease (CKD) patients. CKD patients, including those treated by dialysis, may have a high propensity for falls. Several factors are probably invo lved, including accelerated aging with deleterious consequences such as impaired cognitive function, neurological disorders, v...
Source: Kidney International - Category: Urology & Nephrology Authors: Tags: Letter to the Editor Source Type: research
AbstractObjectiveThe correlation of serum fibroblast growth factor 23 (FGF-23) and Klotho protein levels with bone mineral density (BMD) in maintenance hemodialysis (MHD) patients was analyzed.MethodsBetween January 2015 and November 2015, 125 MHD patients in our hospital were enrolled. Dual-energy X-ray absorptiometry was used to examine the BMD in the femoral neck and lumbar spine of MHD patients. The patients were divided into three groups: a normal bone mass group, an osteopenia group, and an osteoporosis group. An ELISA was performed to measure serum FGF-23, Klotho protein, and 1,25(OH)2VitD3 levels. Other parameters,...
Source: European Journal of Medical Research - Category: Research Source Type: research
Publication date: Available online 9 March 2018 Source:American Journal of Kidney Diseases Author(s): Kavitha Vellanki, Susan Hou Most women with dialysis-dependent chronic kidney disease (CKD) stage 5 (CKD stage 5D) are in the postmenopausal age group. Early menopause is reported for all CKD stages (stages 3-5D). The traditional definition of menopause is not applicable in CKD stage 5(D) because menses can resume with hormone replacement therapy or kidney transplantation. Treatment of vasomotor symptoms continues to be the primary indication for hormone replacement therapy, with no dosing studies done specifically for CK...
Source: American Journal of Kidney Diseases - Category: Urology & Nephrology Source Type: research
AbstractIntroductionIn renal transplant patients, bone loss may be related to the drugs patients are taking but also to their past history of chronic kidney disease. The purpose of this study was to assess changes in BMD 2  years after an initial assessment (performed 9 months post transplantation) and the factors associated with these changes.MethodsThis longitudinal study included patients who had undergone a renal transplantation between 2005 and 2011, and who were followed up at the Lille Regional University Hospital. Patients were included if they had a first bone evaluation (including bone densitometry, spi...
Source: Osteoporosis International - Category: Orthopaedics Source Type: research
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