Introduction:

Chronic Kidney Disease (CKD) is associated with abnormal bone metabolism and increased fragility fracture risk. This overlap between CKD and osteoporosis in the context of the ageing population adds more challenges to care of the elderly. However, many older people often have both CKD and osteoporosis, but are undiagnosed and untreated. The objective of this study is to measure prevalence of CKD among patients presenting with fragility fractures.

Methods:

A total of 2073 fragility fracture patients seen by Aneurin Bevan Fracture Liaison Service (AB-FLS) between January 2022 and March 2023 were reviewed retrospectively; 825 patients' fragility fracture were excluded due to non-availability of estimated glomerular filtration rate (eGFR); and 1108 patients with fragility fractures were assessed for the stage of CKD based on eGFR. CKD stages were classified based on eGFR (mL/min/1.73 m²) values: stage 2 (60–89); stage 3 (30–59); stages 4 (15-29); and stage 5 (<15). Subgroup analyses were performed by fracture type.

Results:

Mean age (n=2073 patients) = 78.2±10.6 and routine bloods for all patients showed mean Hb = 123 (49-192); MCV= 93.89 (60 -142); Calcium=2.39 (1.62-3.22); Phosphate= 1.11 (0.10-2.97); ALP=113 (15-4470); and mean creatinine was 88 (range=27-810).

The mean age for patients with available eGFR (n=1108) was 82.3±9.0 and mean eGFR was 60 (range=5-89).

The prevalence of CKD stage 2 was 52.2% (n=579) and the mean age was 80.3±9.4 (50 to 102). Nearly half of the fragility fracture patients (47.8%, n=529) had CKD stage 3 or above and the mean age was 84.5±8.0 (50 to 102). There was a significant difference in group mean age (p<0.0001).

The proportion of patients with stages 3, 4 and 5 were 41.9% (n=464), 4.9% (n=55), and 1.1% (n=13), respectively.

Conclusion:

Nearly half of the patients who sustained a fragility fracture and a quarter with hip/femur fracture had CKD 3 or above and were significantly older compared to CKD stage 2. More research is needed to close this gap, so we can better understand how to manage bone health in older people living with CKD and prevent future fragility fractures.