P1389
MAJOR OSTEOPOROTIC FRACTURES AFTER INITIATION OF DIALYSIS: INCIDENCE, PREDICTORS AND ASSOCIATION WITH MORTALITY Free

Major osteoporotic fractures (MOF) are common in dialysis patients. We investigated incidence, predictors and clinical outcomes associated with first MOF occurring after initiation of dialysis (MOF_first).

In Swedish Renal Registry of 9714 incident (2005 -2016) dialysis patients (median age 68 years, 67% men), we identified all MOF_first in hip, spine, humerus and forearm. Using flexible parametric hazard models and Fine-Gray analysis, we estimated incidence, mortality rates and predictors of MOF_first, and, in time-dependent analysis, risk of all-cause and cardiovascular disease (CVD) mortality following MOF_first.

During median follow-up of 2.2 years, the crude incidence rate of MOF_first (n=835) was 24/1000 patient-years (pt-yrs) and that of hip fractures (n=470) 13/1000 pt-yrs. The multivariate-adjusted fracture incidence rates increased gradually after dialysis initiation and were 47% higher among women. Female sex, higher age, presence of comorbidities, and previous history of MOF (MOF_previous) were associated with increased risk for MOF_first, whereas peritoneal dialysis as compared to hemodialysis was associated with decreased fracture risk. The adjusted fracture incidence rate of MOF_first during the first 90 days following dialysis initiation was higher in patients with MOF_previous than in those without MOF_previous. MOF_first independently predicted increased all-cause mortality (sub-distribution hazard ratio, sHR, 1.67(95%CI 1.47-1.91) and CVD-related mortality (sHR 1.49 (95%CI 1.22-1.84). Adjusted mortality rate following hip fractures was higher than for other types of MOF. Spline curves showed that mortality following MOF_first was highest during the first 6 months of follow-up.

Major osteoporotic fractures are common and associated with increased mortality in incident dialysis patients.