Osteoporotic fractures tied to death, allograft loss in kidney transplant recipients

Osteoporotic fractures do not occur frequently among kidney transplant recipients but when they do, they contribute to increased risks of death and allograft loss, according to a retrospective cohort study.

The study included 145,090 Korean patients who had recently received a diagnosis of kidney failure. Incident osteoporotic fractures were examined in relation to kidney transplantation vs dialysis, while death was analysed in relation to osteoporotic fractures.

The analysis included 11,413 pairs of patients receiving maintenance dialysis and recipients of kidney allografts. These two groups were matched according to age, sex, year of new index date, duration of dialysis, and presence of hypertension and diabetes mellitus.

Osteoporotic fractures occurred in 5.2 percent of allograft recipients and in 5.6 percent of matched dialysis comparators. Over 5.5 years of follow-up, the risk of incident osteoporotic fractures was 27-percent lower among kidney transplant recipients than among matched dialysis comparators (adjusted hazard ratio [aHR], 0.73, 95 percent confidence interval [CI], 0.64–0.84; p<0.001). This difference was driven by higher rates of hip fractures among dialysis patients.

Notably, incident osteoporotic fractures were associated with significantly increased mortality (aHR, 2.18, 95 percent CI, 1.57–3.02; p<0.001) and death-censored allograft failure (aHR, 1.42, 95 percent CI, 1.02–1.97; p=0.040).

The study was limited by the lack of data on bone mineral density or hyperparathyroidism and the use of claims data, among others.