Comparing Fracture Risk and Frailty Scores in Patients on Haemodialysis

Background: Bone disease is common among patients with chronic kidney disease undergoing haemodialysis (HD) and contributes to fragility fractures. According to KDIGO (2017) guidelines, individuals with CKD stages G3a to G5D with evidence of mineral bone disease (MBD) and/or risk factors for osteoporosis should undergo fracture risk assessment, if the outcome would impact treatment decisions. Frailty is another recognized risk factor for fragility fractures. The Fracture Risk Assessment Tool (FRAX) assesses fracture risk in people with osteoporosis. The Clinical Frailty Scale (CFS) is a validated nine-point tool measuring cognition, function, co-morbidities, and mobility in patients over 65. The aim of this study was to assess and compare fracture risk using the FRAX® tool and identify frailty incidence using the CFS between two haemodialysis units, one of which lacked a physiotherapy service. Assessing fracture risk and frailty helps guide patient management through pharmacotherapy, CKD-MBD optimization, and physical therapy. Methods: Sample Size: 119 (Mater Hospital: 76 patients + Satellite unit: 43 patients) Inclusion Criteria: chronic HD outpatients attending the Mater between October 2023 – January 2024 and the satellite unit between January 2025- February 2025. Exclusion Criteria:Patients requiring acute HD or inpatients during that time. Results: The FRAX score revealed that the Mater patients (4.03%) and the satellite unit patients (4.1%) had similar 10-year hip fracture probability. The satellite unit, however, had a higher 10-year probability of a major osteoporotic fracture (12.2%) compared to the Mater unit (10.1%). In terms of frailty, 73% of Mater patients were mildly frail (CFS 5) versus 44% in the satellite group. Severe frailty was noted in 16% of Mater patients, while none in the satellite group. It was noted that 3 patients were on denosumab in the Mater hospital while only 1 patient was on denosumab in the satellite unit. Conclusion: This data reveals a high fracture risk amongst incident HD patients. The low proportion of patients prescribed specific treatment, such as denosumab, reflects the challenges of diagnosing and treating low bone mineral density in this cohort. Features of frailty overlap with risk factors for fragility fractures; this highlights the importance of providing patients with a multidisciplinary management plan.