Researchers looked at 35 years of medical records to understand why people with severe kidney disease have more hip fractures. They studied over 230,000 patients and found that hip fractures in kidney disease patients skyrocketed from 1977 to 2007, then started to decrease slightly. The study shows that kidney disease patients who break their hips tend to be older and White, and that spending years on dialysis (a treatment for kidney disease) increases fracture risk. These findings help doctors understand why kidney disease affects bone health and could lead to better ways to protect bones in these patients.

The Quick Take

  • What they studied: Whether people with end-stage kidney disease (the most severe form) get hip fractures more often than other people, and what changed over 35 years
  • Who participated: Two groups of about 115,000 kidney disease patients each—one group that had hip fractures and one that didn’t. The groups were matched by age and sex to make fair comparisons. Most participants were older (average age 71) and about 77% were White.
  • Key finding: Hip fractures in kidney disease patients increased dramatically (over 3,000%) between 1977 and 2007, but then decreased by 11% from 2007 to 2012. This is very different from what happened in the general population, where hip fractures stayed more stable.
  • What it means for you: If you have severe kidney disease, you have a higher risk of breaking your hip, especially as you get older. This suggests doctors should pay special attention to bone health in kidney disease patients. However, the recent decrease in fractures suggests that newer treatments may be helping protect bones better.

The Research Details

Researchers used a large national database of kidney disease patients in the United States that has been tracking patients since 1977. They compared two groups of patients with kidney disease: those who had hip fractures and those who didn’t. By matching patients by age and sex, they could see if other factors (like race or how long they’d been on dialysis) made a difference in who got fractures.

This type of study is called a ‘cohort study’ because researchers follow groups of people over time and compare outcomes. The researchers looked backward at 35 years of records to spot patterns and trends. They used statistical tests to determine if differences between groups were real or just due to chance.

This study is important because it’s one of the largest ever done on this topic, looking at over 230,000 patients across 35 years. By examining such a long time period, researchers could see how hip fractures in kidney disease patients have changed as treatments improved. Understanding these trends helps doctors figure out what’s working and what still needs improvement.

The study’s strengths include its large sample size (over 230,000 patients), long time period (35 years), and use of a national database that tracks real patients. The researchers carefully matched comparison groups by age and sex to make fair comparisons. However, because this is a retrospective study (looking backward at records), researchers couldn’t control all the factors that might affect fracture risk. The study also doesn’t explain why the decrease happened after 2007—it could be due to better treatments, changes in how kidney disease is managed, or other factors not measured in this study.

What the Results Show

The most striking finding is the huge increase in hip fractures among kidney disease patients from 1977 to 2007—a 3,369% increase. This means that in 1977, hip fractures were very rare in this population, but by 2007, they had become much more common. However, from 2007 to 2012, the trend reversed slightly, with a 11% decrease in new hip fractures.

This pattern is very different from what happens in the general population. In the general U.S. population, hip fractures have stayed relatively stable or even decreased over the same time period. The difference suggests that kidney disease itself, and the treatments for it (especially dialysis), are major risk factors for hip fractures.

The researchers also found that patients with kidney disease who broke their hips were slightly more likely to be White (77.7% vs. 76.1% in the comparison group) and slightly older (average age 71.6 vs. 71.2). There was no difference between males and females in fracture rates.

The study suggests that the increased lifespan of kidney disease patients may be partly responsible for the rise in hip fractures. Because modern treatments keep these patients alive longer, they spend more years on dialysis—and dialysis itself is a known risk factor for weak bones. The research also supports the idea that White patients may have genetic differences in how their bodies handle vitamin D and other minerals important for bone health, which could explain why they have higher fracture rates.

These findings align with what other kidney disease research has shown: that kidney disease patients do have weaker bones and more fractures. However, this study is unique because it shows the long-term trend over 35 years. The recent decrease in fractures (after 2007) is encouraging and suggests that newer approaches to managing kidney disease and bone health may be working better than older treatments.

Because this study looked backward at medical records rather than following patients forward, researchers couldn’t control for all the factors that might affect fracture risk (like diet, exercise, or medication use). The study also doesn’t explain why fractures decreased after 2007—it could be due to better bone-protecting medications, improved dialysis techniques, or other changes in treatment that weren’t measured. Additionally, the study only includes data through 2012, so it doesn’t show what’s happened in more recent years. Finally, the study doesn’t explain the biological reasons why White patients have higher fracture rates, only that they do.

The Bottom Line

If you have severe kidney disease, talk to your doctor about protecting your bones. This might include getting enough calcium and vitamin D, doing weight-bearing exercise if possible, and having your bone density checked regularly. Your doctor may also recommend medications to strengthen bones. These recommendations are based on solid evidence from large studies like this one. (Confidence level: Moderate—the evidence is strong that kidney disease increases fracture risk, but individual treatment plans should be personalized by your doctor.)

This research is most relevant for people with end-stage kidney disease, especially those over age 65 and those who have been on dialysis for many years. It’s also important for kidney disease doctors and specialists who manage bone health. People with early-stage kidney disease should be aware that bone health becomes increasingly important as kidney disease progresses. Family members of kidney disease patients should also understand this risk so they can support preventive care.

Bone-strengthening treatments typically take several months to show effects. You might notice improvements in bone density within 6-12 months of starting treatment, though fracture prevention is a long-term goal. The decrease in fractures shown in this study happened over many years as treatments improved, so patience and consistency with bone health strategies are important.

Want to Apply This Research?

  • Track bone health markers monthly: record any falls or near-falls, note any bone or joint pain, and log calcium and vitamin D intake. If using a fitness app, track weight-bearing activities like walking. Share these records with your kidney disease doctor at appointments.
  • Set a daily reminder to take calcium and vitamin D supplements as prescribed. Log each dose in the app. Also track weight-bearing activities (walking, light resistance exercises) that help maintain bone strength. Aim for at least 30 minutes of movement most days, as approved by your doctor.
  • Use the app to track trends over 3-6 months: Are you having fewer falls? Is your pain decreasing? Are you consistently taking supplements? Schedule regular check-ins with your kidney disease doctor (typically every 3-6 months) to review bone health and adjust treatments if needed. Request bone density scans (DEXA scans) as recommended by your doctor, typically every 1-2 years.

This research describes trends in hip fractures among kidney disease patients but does not provide individual medical advice. If you have kidney disease or are concerned about bone health, consult with your nephrologist (kidney specialist) or primary care doctor before making any changes to your treatment plan. This study shows associations between kidney disease and hip fractures but does not prove that one directly causes the other. Individual risk factors vary greatly, and personalized medical evaluation is essential for appropriate care.