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.
Systematic review and meta-analysis.
Adults with CKD glomerular filtration rate (GFR) categories 3a-5D (G3a-G5D) compared with adults without CKD G3a-G5D.
Observational studies.
Data extraction was conducted by 1 reviewer and checked by a second reviewer.
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.
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.
We could not assess the effects of bone mineral density, biochemical abnormalities, renal osteodystrophy, frailty, falls, or medications on risk for fractures.
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.
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。
系统评价和荟萃分析。
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。
观察性研究。
由一名审查员进行数据提取，由第二名审查员进行核对。
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。
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。
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。
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。
