Dr Louise Keamy1, Dr Nicole Marie Lioufas1,2,3,4, Craig Nelson1,
1Department of Nephrology – Western Health, Melbourne, Australia, 2Department of Nephrology – RMH, Melbourne, Australia, 3Department of Medicine – RMH, Melbourne, Australia, 4The University of Melbourne, Melbourne, Australia
Aim: To determine the outcomes of fragility fractures in dialysis patients and determine if they have specific investigation, management and follow-up into their chronic kidney disease mineral bone disorder (CKD-MBD) with the aim to prevent further fracture.
Background: When patients reach dialysis, CKD-MBD increases their risk of fracture in this population, and results in higher mortality in contrast to the general population. Due to the paucity of evidence for prevention of fracture, investigation and management of bone health is challenging and may not be routinely organised to allow for the consideration of anti-resorptive options if appropriate.
Methods: A retrospective cohort analysis of Western Health dialysis patients was conducted between 2011-2021. Admitted patients were identified via ICD coding of medical records. Patients with other disorders requiring specialist bone mineral follow-up were excluded from long term analysis.
Results: 62 fractures were identified in 52 admitted patients. Mean age 72 ± 14 years, 96% of patients on haemodialysis. Fractures comprised of 56% hip, 29% vertebral and 15% wrist. Mean serum phosphate at first fracture was 1.62 ± 0.56 mmol/L, mean serum calcium 2.38 ± 0.17mmol/l, median serum PTH 24.7pmol/L (IQR 21.4-39.6). 19% of patients died during admission, with 20% voluntarily ceasing dialysis during that admission. 29% of remaining patients had a referral to a specialist metabolic bone service post discharge. Few patients were treated subsequently with antiresorptives, with 1 patient identified on a bisphosphonate and 3 patients on denosumab,
Conclusions: Admitted patients with fragility fractures have a high mortality rate during their admission. Unfortunately, not all patients who fracture undergo specific investigation and management into their metabolic bone disease to prevent further fracture.
Biography:
Louise Keamy is currently a third-year Basic Physician Trainee at Western Health in Melbourne, with an interest in nephrology. She completed a Doctor of Medicine at University of Melbourne in 2018. Prior to medicine, Louise worked as a pharmacist, specialising in clinical research within the areas of oncology and haematology.