Fracture Prediction and Prevention in Individuals with Chronic Kidney Disease

Patients with chronic kidney disease (CKD) face increased fracture risk yet our understanding and management of this risk remains poor. We conducted three studies using retrospective cohort analysis in Ontario, Canada. We developed a 3-year fracture prediction model for patients receiving dialysis. Secondly, we contrasted fracture rates among patients on SGLT2i or DPP4i medications, stratified by kidney function. Lastly, we examined hypocalcemia incidence post-denosumab prescription, stratified by kidney function.Findings: The fracture risk tool, incorporating demographic and lab data, performed well (AUC 0.72). SGLT2i did not elevate fracture risk vs. DPP4i (HR 0.95 [95% CI 0.79,1.13]). In those prescribed denosumab, hypocalcemia occurred in 0.6% overall but increased to 24.1% in those with eGFR/min/1.73m². These studies contribute to our understanding of the causes and prediction of fractures in patients with CKD. Further validation of the risk score and research into the efficacy of denosumab and management of hypocalcemia are warranted.