Mortality outcomes with advancing chronic kidney disease in fragility fractures patients

Rashpinder Kaur; Amara Williams; Avtar Singh; Sophie Shah; Chris Edwards; Inderpal Singh

doi:10.1530/obabs.08.OC2.13

Introduction: Chronic Kidney Disease (CKD) affects 5-10% of the world population and is associated with increased fragility fracture risk and mortality. The objective of this study is to measure impact of CKD stage on mortality in fragility fracture patients.

Methods: 6786 fragility fracture patients seen by Aneurin Bevan Fracture Liaison Service (AB-FLS) between January 2022 and December 2024 were reviewed retrospectively. 2354 patients fragility fracture were excluded due to non-availability of estimated glomerular filtration rate (eGFR). All patients with available eGFR (n4432) were categorised into three groups based on eGFR; Group 1: ≥60 ml/min/1.73 m2; Group 2: 4559 ml/min/1.73 m2; andGroup 3 45 ml/min/1.73 m2 for statistical analyses, corresponding to KDIGO stages≥G2, G3a, and≤G3b for statistical analyses.

Results:

Table 1: Patient characteristics
	All patients	Group 1 (>60 ml/min/1.73 m2)	Group 2 (45-59 ml/min/1.73 m2)	Group 3 (<45 ml/min/1.73 m2)	P-value (Group 1 and 2)	P-value (group1 and 3)
n	4432	2819	897	716
Age	80.9±2.70 (50.3-105.1) N=4432	79.1±1.90 (50.4-105.1) N=2819	83.4±1.25 (50.3-103.2) N=897	85.0±3.49 (51.6-104.4) N=716	P < 0.0001	P < 0.0001
Gender	Females=73.4% (3255) N=4432	Females=71.8% (2026) N= 2819	Females=77.1% (692) N=897	Females=75.0% (537) N=716	P = 0.002	P = 0.087
Previous h/0 Fragility fracture	52.6% (2334/4432)	52.3% (1475/2819)	53.7% (482/897)	52.6% (377/716)	P = 0.46	P = 0.89
Admitted to hospital	66.2% (2930/4423)	63.0% (1772/2812)	67.8% (608/896)	76.9% (550/715)	P = 0.009	P < 0.0001

Conclusion: This study demonstrates a clear association between declining kidney function and substantially increased mortality following fragility fractures, with a pronounced escalation in risk from CKD stage 3B onwards. These findings underscore the need for proactive, multidisciplinary models of care, involving a dedicated FLS pharmacist to support informed, individualised treatment decisions.

Table 2. Clinical outcomes
	All patients	Stage 1 (>60 ml/min/1.73 m2)	Group 2 (45-59 ml/min/1.73 m2)	Group 3 (<45 ml/min/1.73 m2)	P-value (Group 1 and 2)	P-value (group1 and 3)
n	4432	2819	897	716
30-day mortality	232	108/2819 3.83%	43/897 4.79%	81/716 11.31%	P = 0.20	P < 0.0001
90-day mortality	458	229/2819 8.12%	92/897 10.26%	137/716 19.13%	P = 0.047	P < 0.0001
One-year mortality	961	524/2819 18.59%	186/897 20.74%	251/716 35.06%	P = 0.15	P < 0.0001
Overall mortality	1322	726/2819 25.75%	278/897 30.99%	318/716 44.41%	P = 0.0021	P < 0.0001

Bone Abstracts

OC2.13