Subgroup-Specific Osteoporosis Risk in Chronic Kidney Disease: Insights from a Nationwide Korean Cohort

<b>Background/Objectives</b>: Chronic kidney disease (CKD) and osteoporosis are critical public health concerns, particularly among older adults, due to their prevalence and associated complications. While CKD-related disruptions in bone mineral metabolism are believed to increase osteoporosis risk, this relationship remains unclear in diverse populations such as Korea. <b>Methods</b>: This longitudinal cohort study utilized data from the Korean National Health Insurance Service Health Screening Cohort (2002-2019), including 13,622 patients with newly diagnosed CKD and 54,488 matched controls. CKD was defined as having at least two outpatient or inpatient records with ICD-10 codes N18 or N19 and/or evidence of dialysis treatment claims, following a 1-year washout period to exclude prevalent cases. Individuals with a prior history of osteoporosis or incomplete baseline data were excluded. Propensity score overlap weighting was applied, and adjusted hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated using Cox proportional hazards models, with subgroup analyses based on demographic and clinical factors. <b>Results</b>: CKD was not associated with an increased risk of osteoporosis. On the contrary, CKD patients exhibited an 18% lower risk of developing osteoporosis compared to controls (HR = 0.82, 95% CI: 0.77-0.87, <i>p</i> < 0.001). This inverse association was more pronounced among women, non-smokers, individuals with low alcohol consumption, and those with a higher comorbidity burden. <b>Conclusions</b>: These findings suggest that certain subgroups of CKD patients may have a reduced risk of osteoporosis, highlighting the importance of individualized risk assessment and tailored preventive strategies.