Vertebral fracture is associated with myocardial infarction in incident hemodialysis patients: a Korean nationwide popul
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ORIGINAL ARTICLE
Vertebral fracture is associated with myocardial infarction in incident hemodialysis patients: a Korean nationwide population-based study Y.E. Kwon 1 & H.Y. Choi 2 & H.J. Oh 3 & S.Y. Ahn 4 & D.-R. Ryu 5 & Y.J. Kwon 4 Received: 21 November 2019 / Accepted: 14 April 2020 # International Osteoporosis Foundation and National Osteoporosis Foundation 2020
Abstract Summary Chronic kidney disease (CKD)-mineral and bone disorder suggests that fragile bone and vascular disorder might be connected closely in CKD patients. In this study, fracture event was significantly associated with myocardial infarction (MI) in end-stage renal disease patients on hemodialysis (HD), especially for vertebral fractures. Introduction CKD-mineral and bone disorder is characterized by biochemical abnormalities, bone disorders, and vascular calcification. We aimed to verify the association between fracture and MI in CKD patients. Methods Records for incident CKD stage 3 to 5 patients and patients who initiated HD between July 2014 and June 2018 were retrieved from the Korean Health Insurance Review & Assessment Service Database. Fractures were defined using diagnostic codes and were classified into vertebral, femoral, and other site fractures. MI was defined using a combination of MI diagnostic codes and related procedure codes. Multiple logistic regressions and 1:1 propensity score matching analysis were conducted. Results A total of 38,935 patients (HD, 11,379; pre-dialysis CKD, 27,556) were included in this study. A total of 5,057 (13.0%) patients experienced fracture, and 1,431 (3.7%) patients had MI. Multiple logistic regression analysis showed that fracture was significantly associated with MI in the HD group (odds ratio (OR) 1.34, P = 0.024), but not in the pre-dialysis CKD group (OR 1.04, P = 0.701). After propensity score matching for age, gender, and diabetes mellitus between patients with and without fracture, fracture still significantly correlated with MI in HD patients (OR 1.47, P = 0.034) but not in patients with pre-dialysis CKD (OR 1.04, P = 0.751). Subgroup analysis by fracture site found that vertebral fracture was associated with MI in HD patients (OR 2.11, P = 0.024), but femoral or other site fractures were not. Conclusion In HD patients, fracture was significantly associated with MI, especially for vertebral fractures patients. Keywords Fracture . Hemodialysis . Myocardial infarction . Vertebral
Abbreviations CI Confidence interval CKD Chronic kidney disease ESRD End-stage renal disease
FGF-23 HD HIRA IRB
Fibroblast growth factor-23 Hemodialysis Health Insurance Review & Assessment Service Institutional review board
D.-R. Ryu and Y.J. Kwon contributed equally to this work. Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00198-020-05423-y) contains supplementary material, which is available to authorized users. * D.-R. Ryu [email protected] * Y.J. Kwon [email protected] 1
Department of Internal Medicine, Hanyang University College of Medicine, Myongji Hos
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