Fractures and Subsequent Graft Loss and Mortality among Older Kidney Transplant Recipients.
OBJECTIVES
Older adults who undergo kidney transplantation (KT) are living longer with a functioning graft and are at risk for age-related adverse events including fractures. Understanding recipient, transplant, and donor factors and the outcomes associated with fractures may help identify older KT recipients at increased risk. We determined incidence of hip, vertebral, and extremity fractures; assessed factors associated with incident fractures; and estimated associations between fractures and subsequent death-censored graft loss (DCGL) and mortality.


DESIGN
This was a prospective cohort study of patients who underwent their first KT between January 1, 1999, and December 31, 2014.


SETTING
We linked data from the Scientific Registry of Transplant Recipients to Medicare claims through the US Renal Data System.


PARTICIPANTS
The analytic population included 47 815 KT recipients aged 55 years or older.


MEASUREMENTS
We assessed the cumulative incidence of and factors associated with post-KT fractures (hip, vertebral, or extremity) using competing risks models. We estimated risk of DCGL and mortality after fracture using adjusted Cox proportional hazards models.


RESULTS
The 5-year incidence of post-KT hip, vertebral, and extremity fracture for those aged 65 to 69 years was 2.2%, 1.0%, and 1.7%, respectively. Increasing age was associated with higher hip (adjusted hazard ratio [aHR] = 1.37 per 5-y increase; 95% confidence interval [CI] = 1.30-1.45) and vertebral (aHR = 1.31; 95% CI = 1.20-1.42) but not extremity (aHR = .97; 95% CI = .91-1.04) fracture risk. DCGL risk was higher after hip (aHR = 1.34; 95% CI = 1.12-1.60) and extremity (aHR = 1.30; 95% CI = 1.08-1.57) fracture. Mortality risk was higher after hip (aHR = 2.31; 95% CI = 2.11-2.52), vertebral (aHR = 2.80; 95% CI = 2.44-3.21), and extremity (aHR = 1.85; 95% CI = 1.64-2.10) fracture.


CONCLUSION
Our findings suggest that older KT recipients are at higher risk for hip and vertebral fracture but not extremity fracture; and those with hip, vertebral, or extremity fracture are more likely to experience subsequent graft loss or mortality. These findings underscore that different fracture types may have different underlying etiologies and risks, and they should be approached accordingly. J Am Geriatr Soc 67:1680-1688, 2019.
['Salter|Megan L|ML|', 'Liu|Xinran|X|', 'Bae|Sunjae|S|', 'Chu|Nadia M|NM|', 'Miller Dunham|Alexandra|A|', 'Humbyrd|Casey|C|', 'Segev|Dorry L|DL|', 'McAdams-DeMarco|Mara A|MA|']
D000368:Aged D000369:Aged, 80 and over D005260:Female D050723:Fractures, Bone D006084:Graft Rejection D006801:Humans D015994:Incidence D016030:Kidney Transplantation D008297:Male D006278:Medicare D011183:Postoperative Complications D016016:Proportional Hazards Models D011446:Prospective Studies D012042:Registries D012307:Risk Factors D014481:United States
fractures graft loss mortality kidney transplant older adults