(13) Prevalence of Osteoporosis, Fractures, and Preventive Therapy Among Patients with Moderate to Severe Chronic Kidney Disease Patients Using National Heath and Examination Survey (NHANES)

Publication Number: 687

Background: Chronic kidney disease (CKD) individuals are at higher risk of mineral bone disorders, reduced bone mineral density (BMD) and incident fractures. Guidelines recommend the assessment of BMD and early therapeutic interventions to reduce risk of fall, fractures, and associated comorbidities. Nationally representative data on osteoporosis (OP) and treatment among individuals with CKD are limited.

Objectives: To estimate the prevalence of OP among moderate to severe CKD patients in the US and identify patterns of prescribed therapeutic medications.

Methods: We used NHANES cross-sectional survey data from 2013-2014 and 2017-2020 (no OP survey in 2015-2016). Eligible participants: adults ≥ 40 years for 2013-2014 data and ≥ 50 years for 2017-2020 who responded to the survey and had a serum creatinine measure. We determined kidney function by estimated glomerular filtration rate (eGFR) using Chronic Kidney Disease-Epidemiology (CKD-EPI) creatinine equation 2021. We defined individuals with moderate to severe CKD as those with eGFR < 60 ml/min/1.73 m2. Prescription and supplement use were based on interviewer review of bottles on hand. All other survey data were self-reported by participants.

Results: We identified 7776 eligible participants of whom 51.3% were female and 13.6% had moderate to severe CKD. Mean± SD for age, body mass index were 62±11 years, 29.7±7.0 kg/m2 respectively, and median eGFR was 86.6, IQR (70.4, 99.1) ml/min/1.73m2.
Prevalence of OP was 15.2% vs. 9.6% among individuals with and without moderate to severe CKD respectively, prevalence difference (PD) 5.6% (95% CI 3.3%, 7.9%). Past hip fracture was 3.2% vs. 2.0% among individuals with and without moderate to severe CKD, [PD=1.2%, 95% CI (0.17%, 2.3%)]. Spinal fracture did not differ between those with vs. without moderate to severe CKD [PD=0.06% ,95% CI (-1.02%, 1.2%)].
Self-reported history of any prescription medication for OP was 56.5% vs. 52.2% among individuals with and without moderate to severe CKD. Among individuals with OP, 13.0% vs 14.6% with and without moderate to severe CKD, respectively, had a current prescription of OP medication. Bisphosphonates were the main pharmacological prescribed class (90.4%), with calcium supplements and vitamin D reported by 20.1% and 20.8% respectively among moderate to severe CKD individuals.

Conclusions: OP and hip fracture were more prevalent among moderate to severe CKD individuals compared to individuals with eGFR ≥ 60 ml/min/1.73 m2. We identified substantial unmet need in treatment of OP in general population and among those vulnerable individuals to reduce incident fractures, comorbidities, and healthcare costs.