Background Hip fractures (HF) are associated with significant morbidity and are further increased in patients with chronic renal failure (CRF). Higher morbidity in dialysis patients is related to several risk factors that are associated. Dementia is an associated risk factor for HF in the general population.
Objectives We here aimed to describe the impact of dementia in FH in dialysis patients and assess if dementia is an additional risk factor of HF in patients with CRF.
Methods Data are obtained from the National Database of Hospitalizations. In order to avoid the possibility of a high incidence based in single year, data were extracted over the period 2011-2013. Three populations of subjects aged 60 and over were extracted and analyzed: population with hip fracture, population in dialysis and population of demented patients (whatever the reason for the hospitalization whether or not in connection with dementia). These populations were crossed to estimate the 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 to 2013, 213 180 patients experienced a hip fracture (70% women), 660 434 patients were diagnosed for dementia (64% women) and 47 430 patients were on dialysis (39% women). There was an effect of age and gender on the incidence of fractures and dementia.
In dialysis patients, the risk of HF was significantly higher in patients with dementia compared to those 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]) in each age categories. However, in patients with dementia, the fracture risk is independent of dialysis (OR: 1.25 [0.99-1.59]) in each gender and age categories. Moreover, 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 gender.
Conclusions Dementia significantly increases the risk of hip fracture in dialysis patients compared to the patients without dementia. However, this risk is the same than in demented patients whether in dialysis or not. These results highlight dementia as a major risk factor for FH in dialysis and points out the necessity of prevention to avoid hip fractures.
Disclosure of Interest None declared