Association of osteoporosis treatment with risk of fracture, cardiovascular disease, and all-cause mortality in patients on maintenance dialysis: a retrospective database study using real-world data in Japan

BACKGROUND: Patients with chronic kidney disease who have progressed to dialysis treatment have increased fracture risk. However, the impact of osteoporosis treatment on fracture risk has not been evaluated in a large-scale study using Japanese real-world data. METHODS: In this retrospective observational study (UMIN000054749), DeSC-IQVIA Integrated Claims Data were used to investigate the impact of osteoporosis treatment on fracture risk and other events in patients receiving maintenance hemo- or peritoneal dialysis. Data from April 2014 to August 2022 were extracted, and patients were divided into treated/untreated groups based on prescription records for osteoporosis medications during a 1-year exposure assessment period. The primary endpoint was the incidence of total and hip fractures from the index date (1 year post-exposure assessment period) until the end of follow-up. RESULTS: Of 156,557 patients receiving maintenance dialysis for ≥ 1 year, 38,246 were included: 1093 and 37,153 in the treated and untreated groups, respectively. Although there was a numerically higher fracture incidence in the treated group, no significant difference was observed between the groups overall. As aged, the difference in fracture risk between the groups decreased. Multivariable regression analysis revealed that age, sex, fracture history (primary risk factor), diabetes, and sleep disorder were statistically significant effect modifiers of fracture risk. CONCLUSION: The numerically higher incidence of fractures in the treated group may have been due to patient background differences. Fracture risk management is essential in dialysis patients, and osteoporosis treatment should be considered at an earlier age, taking into account the patient's background.