Department of Oncology and Metabolism, University of Sheffield, Sheffield, United Kingdom.
Department of Oncology and Metabolism, University of Sheffield, Sheffield, United Kingdom.
Am J Kidney Dis. 2020 Oct;76(4):521-532. doi: 10.1053/j.ajkd.2020.02.450. Epub 2020 Jul 9.
RATIONALE & OBJECTIVE: Disordered mineral metabolism complicates chronic kidney disease (CKD), but the effect of reduced kidney function on fracture risk has not been fully established. We conducted a systematic review and meta-analysis of the risks for hip and nonvertebral fractures in people with CKD. We also investigated the effects of age, sex, and CKD stage. STUDY DESIGN: Systematic review and meta-analysis. STUDY POPULATION: Adults with CKD glomerular filtration rate (GFR) categories 3a-5D (G3a-G5D) compared with adults without CKD G3a-G5D. SELECTION CRITERIA FOR STUDIES: Observational studies. DATA EXTRACTION: Data extraction was conducted by 1 reviewer and checked by a second reviewer. ANALYTICAL APPROACH: MEDLINE, EMBASE, and Cochrane databases were searched in March 2018 and an update was conducted in November 2019. We used random-effects models to calculate pooled risk estimates and 95% CIs. RESULTS: 17 studies met the inclusion criteria. We included 13 studies in the hip fracture systematic review and 10 studies in the meta-analysis. Studies reported data from 250,440,035 participants; 5,798,566 with CKD G3a-G5D and 363,410 with hip fractures. 4 studies were included in the nonvertebral fracture analysis, reporting data from 1,396,976 participants; 464,978 with CKD G3a-G5D and 115,284 fractures. Studies reported data from participants aged 18 to older than 90 years. We found a significant increase in fracture risk both for hip (relative risk [RR], 2.36; 95% CI, 1.64-3.39) and nonvertebral fractures (RR, 1.47; 95% CI, 1.15-1.88). For hip fractures, younger patients (<65 years) had higher relative risk (RR, 7.66; 95% CI, 2.76-21.26) than older patients (>65 years; RR, 2.11; 95% CI, 1.41-3.16). Greater GFR loss was associated with higher relative risk for fractures. LIMITATIONS: We could not assess the effects of bone mineral density, biochemical abnormalities, renal osteodystrophy, frailty, falls, or medications on risk for fractures. CONCLUSIONS: Risks for hip and nonvertebral fractures are increased in CKD G3a-G5D. The relative risk of hip fracture is greater in the younger than the older population and increases progressively with loss of GFR. We suggest that fracture prevention should be a consideration in CKD at any age.
背景与目的：矿物质代谢紊乱会使慢性肾脏病（CKD）复杂化，但肾功能下降对骨折风险的影响尚未完全确定。我们进行了一项系统评价和荟萃分析，以评估 CKD 患者髋部和非椎体骨折的风险。我们还研究了年龄、性别和 CKD 分期的影响。 研究设计：系统评价和荟萃分析。 研究人群：与无 CKD G3a-G5D 的成年人相比，CKD 肾小球滤过率（GFR）分级 3a-5D（G3a-G5D）的成年人。 研究选择标准：观察性研究。 数据提取：由一名审查员进行数据提取，由第二名审查员进行核对。 分析方法：2018 年 3 月检索了 MEDLINE、EMBASE 和 Cochrane 数据库，并于 2019 年 11 月进行了更新。我们使用随机效应模型计算了汇总风险估计值和 95%CI。 结果：17 项研究符合纳入标准。我们将 13 项研究纳入了髋部骨折系统评价，10 项研究纳入了荟萃分析。这些研究报告了来自 250440035 名参与者的数据；5798566 名患有 CKD G3a-G5D，363410 名患有髋部骨折。4 项研究纳入了非椎体骨折分析，报告了来自 1396976 名参与者的数据；464978 名患有 CKD G3a-G5D，115284 名患有骨折。这些研究报告的数据来自年龄在 18 岁以上的参与者。我们发现髋部骨折（相对风险 [RR]，2.36；95%CI，1.64-3.39）和非椎体骨折（RR，1.47；95%CI，1.15-1.88）的风险显著增加。对于髋部骨折，年轻患者（<65 岁）的相对风险（RR，7.66；95%CI，2.76-21.26）高于老年患者（>65 岁；RR，2.11；95%CI，1.41-3.16）。肾小球滤过率损失越大，骨折的相对风险越高。 局限性：我们无法评估骨密度、生化异常、肾性骨营养不良、虚弱、跌倒或药物对骨折风险的影响。 结论：CKD G3a-G5D 患者髋部和非椎体骨折的风险增加。与老年人群相比，年轻人群的髋部骨折相对风险更高，且随着 GFR 的下降而逐渐增加。我们建议，在任何年龄，都应考虑预防 CKD 患者骨折。
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