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Risk Factors for Fracture in Patients with Coexisting Chronic Kidney Disease and Type 2 Diabetes: An Observational Analysis from the CREDENCE Trial
BACKGROUND: The fracture pathophysiology associated with type 2 diabetes and chronic kidney disease (CKD) is incompletely understood. We examined individual fracture predictors and prediction sets based on different pathophysiological hypotheses, testing whether any of the sets improved prediction b...
Autores principales: | , , , , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Hindawi
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9168808/ https://www.ncbi.nlm.nih.gov/pubmed/35677742 http://dx.doi.org/10.1155/2022/9998891 |
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author | Young, Tamara K. Toussaint, Nigel D. Di Tanna, Gian Luca Arnott, Clare Hockham, Carinna Kang, Amy Schutte, Aletta E. Perkovic, Vlado Mahaffey, Kenneth W. Agarwal, Rajiv Bakris, George L. Charytan, David M. Heerspink, Hiddo J. L. Levin, Adeera Pollock, Carol Wheeler, David C. Zhang, Hong Jardine, Meg J. |
author_facet | Young, Tamara K. Toussaint, Nigel D. Di Tanna, Gian Luca Arnott, Clare Hockham, Carinna Kang, Amy Schutte, Aletta E. Perkovic, Vlado Mahaffey, Kenneth W. Agarwal, Rajiv Bakris, George L. Charytan, David M. Heerspink, Hiddo J. L. Levin, Adeera Pollock, Carol Wheeler, David C. Zhang, Hong Jardine, Meg J. |
author_sort | Young, Tamara K. |
collection | PubMed |
description | BACKGROUND: The fracture pathophysiology associated with type 2 diabetes and chronic kidney disease (CKD) is incompletely understood. We examined individual fracture predictors and prediction sets based on different pathophysiological hypotheses, testing whether any of the sets improved prediction beyond that based on traditional osteoporotic risk factors. METHODS: Within the CREDENCE cohort with adjudicated fracture outcomes, we assessed the association of individual factors with fracture using Cox regression models. We used the Akaike information criteria (AIC) and Schwartz Bayes Criterion (SBC) to assess six separate variable sets based on hypothesized associations with fracture, namely, traditional osteoporosis, exploratory general population findings, cardiovascular risk, CKD-mineral and bone disorder, diabetic osteodystrophy, and an all-inclusive set containing all variables. RESULTS: Fracture occurred in 135 (3.1%) participants over a median 2.35 [1.88–2.93] years. Independent fracture predictors were older age (hazard ratio [HR] 1.04, confidence interval [CI] 1.01–1.06), female sex (HR 2.49, CI 1.70–3.65), previous fracture (HR 2.30, CI 1.58–3.34), Asian race (HR 1.74, CI 1.09–2.78), vitamin D therapy requirement (HR 2.05, CI 1.31–3.21), HbA1c (HR 1.14, CI 1.00–1.32), prior cardiovascular event (HR 1.60, CI 1.10–2.33), and serum albumin (HR 0.41, CI 0.23–0.74) (lower albumin associated with greater risk). The goodness of fit of the various hypothesis sets was similar (AIC range 1870.92–1849.51, SBC range 1875.60–1948.04). CONCLUSION: Independent predictors of fracture were identified in the CREDENCE participants with type 2 diabetes and CKD. Fracture prediction was not improved by models built on alternative pathophysiology hypotheses compared with traditional osteoporosis predictors. |
format | Online Article Text |
id | pubmed-9168808 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | Hindawi |
record_format | MEDLINE/PubMed |
spelling | pubmed-91688082022-06-07 Risk Factors for Fracture in Patients with Coexisting Chronic Kidney Disease and Type 2 Diabetes: An Observational Analysis from the CREDENCE Trial Young, Tamara K. Toussaint, Nigel D. Di Tanna, Gian Luca Arnott, Clare Hockham, Carinna Kang, Amy Schutte, Aletta E. Perkovic, Vlado Mahaffey, Kenneth W. Agarwal, Rajiv Bakris, George L. Charytan, David M. Heerspink, Hiddo J. L. Levin, Adeera Pollock, Carol Wheeler, David C. Zhang, Hong Jardine, Meg J. J Diabetes Res Research Article BACKGROUND: The fracture pathophysiology associated with type 2 diabetes and chronic kidney disease (CKD) is incompletely understood. We examined individual fracture predictors and prediction sets based on different pathophysiological hypotheses, testing whether any of the sets improved prediction beyond that based on traditional osteoporotic risk factors. METHODS: Within the CREDENCE cohort with adjudicated fracture outcomes, we assessed the association of individual factors with fracture using Cox regression models. We used the Akaike information criteria (AIC) and Schwartz Bayes Criterion (SBC) to assess six separate variable sets based on hypothesized associations with fracture, namely, traditional osteoporosis, exploratory general population findings, cardiovascular risk, CKD-mineral and bone disorder, diabetic osteodystrophy, and an all-inclusive set containing all variables. RESULTS: Fracture occurred in 135 (3.1%) participants over a median 2.35 [1.88–2.93] years. Independent fracture predictors were older age (hazard ratio [HR] 1.04, confidence interval [CI] 1.01–1.06), female sex (HR 2.49, CI 1.70–3.65), previous fracture (HR 2.30, CI 1.58–3.34), Asian race (HR 1.74, CI 1.09–2.78), vitamin D therapy requirement (HR 2.05, CI 1.31–3.21), HbA1c (HR 1.14, CI 1.00–1.32), prior cardiovascular event (HR 1.60, CI 1.10–2.33), and serum albumin (HR 0.41, CI 0.23–0.74) (lower albumin associated with greater risk). The goodness of fit of the various hypothesis sets was similar (AIC range 1870.92–1849.51, SBC range 1875.60–1948.04). CONCLUSION: Independent predictors of fracture were identified in the CREDENCE participants with type 2 diabetes and CKD. Fracture prediction was not improved by models built on alternative pathophysiology hypotheses compared with traditional osteoporosis predictors. Hindawi 2022-05-27 /pmc/articles/PMC9168808/ /pubmed/35677742 http://dx.doi.org/10.1155/2022/9998891 Text en Copyright © 2022 Tamara K. Young et al. https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. |
spellingShingle | Research Article Young, Tamara K. Toussaint, Nigel D. Di Tanna, Gian Luca Arnott, Clare Hockham, Carinna Kang, Amy Schutte, Aletta E. Perkovic, Vlado Mahaffey, Kenneth W. Agarwal, Rajiv Bakris, George L. Charytan, David M. Heerspink, Hiddo J. L. Levin, Adeera Pollock, Carol Wheeler, David C. Zhang, Hong Jardine, Meg J. Risk Factors for Fracture in Patients with Coexisting Chronic Kidney Disease and Type 2 Diabetes: An Observational Analysis from the CREDENCE Trial |
title | Risk Factors for Fracture in Patients with Coexisting Chronic Kidney Disease and Type 2 Diabetes: An Observational Analysis from the CREDENCE Trial |
title_full | Risk Factors for Fracture in Patients with Coexisting Chronic Kidney Disease and Type 2 Diabetes: An Observational Analysis from the CREDENCE Trial |
title_fullStr | Risk Factors for Fracture in Patients with Coexisting Chronic Kidney Disease and Type 2 Diabetes: An Observational Analysis from the CREDENCE Trial |
title_full_unstemmed | Risk Factors for Fracture in Patients with Coexisting Chronic Kidney Disease and Type 2 Diabetes: An Observational Analysis from the CREDENCE Trial |
title_short | Risk Factors for Fracture in Patients with Coexisting Chronic Kidney Disease and Type 2 Diabetes: An Observational Analysis from the CREDENCE Trial |
title_sort | risk factors for fracture in patients with coexisting chronic kidney disease and type 2 diabetes: an observational analysis from the credence trial |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9168808/ https://www.ncbi.nlm.nih.gov/pubmed/35677742 http://dx.doi.org/10.1155/2022/9998891 |
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