Background: Hip fractures (HF) is associated with significant morbidity and is further increased in patients with chronic renal failure (CRF). Higher morbidity in dialysis patients is related to several risk factors, in particular dementia. We here aimed to describe the impact of dementia in FH in dialysis patients and assess if CRF is an additional risk factor of HF in patients with dementia.
Methods: Data are obtained from the National Database of Hospitalizations over the period 2011-2013. Three populations of subjects aged 60 and over were extracted and analysed: population with hip fracture, population in dialysis and population of demented patients (whatever the reason for hospitalisation in connection or not with dementia). These populations were crossed to estimate fracture risk based on the presence of dementia or dialysis, adjusted for age and sex. The fracture risk was calculated using a multiple logistic regression model.
Results: Over the period 2011-2013, 213 180 patients had a HF (70% women), 660 434 patients were diagnosed for dementia (64% women) and 47 430 patients were on dialysis (39% women). There was a strong effect of age and gender in the incidence of fractures and dementia. In dialysis patients, the risk of HF was higher in patients with dementia than without dementia: OR 1.99 [95% CI: 1.66-2.38], this being the same for men OR 2.37 [1.81-3.05] and women OR 2.56 [1-97-3.29] regardless of the age. In patients with dementia, the fracture risk is independent of dialysis OR: 1.25 [0.99-1.59] in each sex and age categories. However, the risk of dementia is not increased by dialysis in this population with HF OR 1.52 [0.77-3] after adjustment for age and sex.
Conclusion: Dementia significantly increases the risk of hip fracture in dialysis patients, but the risk is the same in dialysis patients with dementia than non dialysis patients with dementia. These results highlight dementia as a major risk factor for FH in dialysis.
Disclosure: The authors declared no competing interests.